Topical silver for treating infected wounds

Vermeulen, Hester; Hattem, Jarne M. van; Storm‐Versloot, Marja N.; Ubbink, Dirk T.; Westerbos, S. J.

doi:10.1002/14651858.cd005486.pub2

Cited by 161 publications

(113 citation statements)

References 44 publications

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“…These findings are broadly in agreement with those from relevant systematic reviews. [216][217][218] Only one systematic review considered infection-related outcomes 218 despite silver-impregnated dressings being indicated for use in infected wounds. 238 This scoping review considered the reporting of infection-related variables and found considerable variation at baseline and in terms of outcome definition.…”

Section: Discussionmentioning

confidence: 99%

“…215 Most evidence from systematic reviews does not suggest a benefit of using silver compared with other types of dressings in terms of healing venous leg ulcers. [216][217][218] However, the current evidence is based on group-level data and it is possible that true treatment effects can be concealed when important patient-level prognostic factors are not controlled for. A more powerful analysis based on IPD may be more informative and therefore aid clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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“…Thus, it is not surprising that 2 Cochrane meta-analyses [191,192] have come to the following conclusions: silver can inhibit wound secretion and odor, and some studies showed a promotion of wound healing, but other studies showed a delay in wound healing. Currently, there are not enough studies with high-level evidence for a general recommendation of silver-containing wound dressings to improve wound healing or to treat or prevent wound infections.…”

Section: Silver Ionsmentioning

confidence: 99%

Consensus on Wound Antisepsis: Update 2018

Krämer

Dissemond²,

Kim³

et al. 2017

Skin Pharmacol Physiol

240

215

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Wound antisepsis has undergone a renaissance due to the introduction of highly effective wound-compatible antimicrobial agents and the spread of multidrug-resistant organisms (MDROs). However, a strict indication must be set for the application of these agents. An infected or critically colonized wound must be treated antiseptically. In addition, systemic antibiotic therapy is required in case the infection spreads. If applied preventively, the Wounds-at-Risk Score allows an assessment of the risk for infection and thus appropriateness of the indication. The content of this updated consensus recommendation still largely consists of discussing properties of octenidine dihydrochloride (OCT), polihexanide, and iodophores. The evaluations of hypochlorite, taurolidine, and silver ions have been updated. For critically colonized and infected chronic wounds as well as for burns, polihexanide is classified as the active agent of choice. The combination 0.1% OCT/phenoxyethanol (PE) solution is suitable for acute, contaminated, and traumatic wounds, including MRSA-colonized wounds due to its deep action. For chronic wounds, preparations with 0.05% OCT are preferable. For bite, stab/puncture, and gunshot wounds, polyvinylpyrrolidone (PVP)-iodine is the first choice, while polihexanide and hypochlorite are superior to PVP-iodine for the treatment of contaminated acute and chronic wounds. For the decolonization of wounds colonized or infected with MDROs, the combination of OCT/PE is preferred. For peritoneal rinsing or rinsing of other cavities with a lack of drainage potential as well as the risk of central nervous system exposure, hypochlorite is the superior active agent. Silver-sulfadiazine is classified as dispensable, while dyes, organic mercury compounds, and hydrogen peroxide alone are classified as obsolete. As promising prospects, acetic acid, the combination of negative pressure wound therapy with the instillation of antiseptics (NPWTi), and cold atmospheric plasma are also subjects of this assessment.

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“…Recent clinical studies have demonstrated that in the presence of a clinically infected ulcer, a positive PTB test is highly suggestive of osteomyelitis, but a negative test does not rule out the diagnosis; conversely, in the situation of an apparently uninfected foot wound, a positive PTB test is not specific for osteomyelitis, but this diagnosis is unlikely if the PTB test is negative. [19][20][21][22][23][24][25] This clinical sign is of great importance since early reports in 1995, Grayson et al 16 who explored the possibility of osteomyelitis in wounds by the use of a sterile blunt metal probe. They concluded that the PTB test had a positive predictive value of 89%.…”

Section: -14 Days)mentioning

confidence: 99%

“…20 They went even further by saying that "currently supporting data are too limited to recommend topical antimicrobial therapy". [20][21][22] The use of antimicrobial dressings for DFUs was recently assessed via a systemic review which concluded that current evidence base is too weak to suggest any specific antimicrobial dressing. 23 The management of diabetic foot ulcers pose a challenge to attending clinicians and some advanced and expensive topical antimicrobials have been in use through the last few decades.…”

Section: -14 Days)mentioning

confidence: 99%

Triangle of Wound Assessment Made Easy: Revisited

Mohamed¹,

Lenjawi²

2016

Dermatol Open J

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Objective : We have provided evidence based critical review of the "Triangle of wound assessment made easy". Background: Wound assessment is a vital step in managing patients with acute and chronic wounds in daily clinical practice. The natural progression of most wounds is to heal naturally in a coherent and timely manner, although a minority of wounds will fail to heal. The aim of treating recalcitrant wounds that fail to heal is to control symptoms and delay or prevent complications. One vital step in managing wounds is proper and comprehensive evidence based wound assessment. Methods: We have carried out literature review including systemic reviews, met analysis pertaining wound assessment including international guidelines. Results:We have found few gaps in the proposed "Triangle of wound assessment made easy" which have been addressed accordingly. We have revised the concept of (infection) i.e. "raised white blood cell (WBC) count as a sign of infection" and argued that in up to one-half of patients, even with severe diabetic foot infection raised temperature, WBC count, or sedimentation rate are absent. A second point of concern is the omission of "probing to bone sign" in the diagnostic criteria of local signs of infection. Recent clinical studies have demonstrated that in the presence of a clinically infected ulcer, a positive Probe-to-Bone Test (PTB) test is highly suggestive of osteomyelitis, but a negative test does not rule out the diagnosis; conversely, in the situation of an apparently uninfected foot wound, a positive PTB test is not specific for osteomyelitis, but this diagnosis is unlikely if the PTB test is negative. Lastly, the authors have suggested reducing wound bio burden/manage infection through the use of topical antimicrobial therapy-including antiseptic agents. Topical antiseptics have inconclusive proof of efficacy in various etiology wounds and concern remain regarding their residual cytotoxicity when in contact with newly forming granulating tissues especially when highly concentrated rinse solutions is the common practice in developing countries of the world. Conclusion: On the basis of these analysis, we propose revising the "Triangle of wound assessment made easy" in order to address these gaps and maximize its utility in clinical practice.

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Topical silver for treating infected wounds

Cited by 161 publications

References 44 publications

Wounds research for patient benefit: a 5-year programme of research

Wounds research for patient benefit: a 5-year programme of research

Consensus on Wound Antisepsis: Update 2018

Triangle of Wound Assessment Made Easy: Revisited

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