Risk and clinical impact of bacterial resistance/susceptibility to silver-based wound dressings: a systematic review.

OBJECTIVE: To perform a systematic review of the literature on bacterial resistance, tolerance and susceptibility of silver within the context of wound therapy using silver-based dressings. METHODS: A literature search was carried out using PubMed, Embase and Cochrane Library databases, the focus was whether results from microbiological experimental in vitro tests with reference strains and clinical wound isolates are reflected in clinical practice with regards to their 'resistance' profiles, comparable with those observed for antibiotics. The search results were allocated to six categories: resistance and resistance mechanism, in vitro tests with standard strains and wound isolates, prevalence and incidence, impact on clinical practice and impact on antibiotic therapy as well as reviews, expert opinions and consensus. RESULTS: Based on all findings of the literature, it cannot be confirmed that a related clinical resistance to silver-ions in silver-based dressings has clinical impact, although endogenous and exogenous genetic resistance patterns have been described and intensively investigated. A translation of these genetic resistance-expression structures to phenotypic appearances, similar to those known for antibiotics, has not been demonstrated for silver in the literature. CONCLUSION: It can be concluded that there is no definitive evidence available and further studies should be conducted.

Evidenz von Silber in der Wundbehandlung - Metaanalyse der klinischen Studien von 2000-2015.

HINTERGRUND: Da die wissenschaftliche Evidenz für Silber in der Wundbehandlung meist als unzureichend angesehen wird, besteht für die Anwender eine Unsicherheit hinsichtlich des klinischen Einsatzes. MATERIAL UND METHODIK: Von einer Expertengruppe wurden die publizierten klinischen Studien zu Silber in der Wundbehandlung für den Zeitraum 2000-2015 ausgewertet. ERGEBNISSE: Es konnten 851 Artikel identifiziert werden, von denen 173 Artikel eingeschlossen und kategorisiert wurden. Hierbei fanden sich 31 randomisierte kontrollierte Studien (RCTs) und acht Kohortenstudien. Bei 28 dieser Studien fanden sich statistisch signifikante Endparameter zugunsten von Silber. Thematisch waren dies neun Studien zu Verbrennungen, 20 Studien zu anderen Indikationen (9 x Ulcus cruris venosum, 3 x Dekubitus, 2 x chronische Wunde, 1 x diabetisches Fußsyndrom und 5 x andere Wunden), 16 Studien mit dem Parameter Heilung, zwölf Studien bezogen sich auf Lebensqualität inklusive Schmerz, acht Studien mit Kosteneffektivität und drei Studien mit Reduktion der bakteriellen Keimlast. Auf der Basis dieser Ergebnisse wurde ein Behandlungsalgorithmus für Silber in der Wundbehandlung entwickelt. SCHLUSSFOLGERUNGEN: Diese aktuelle Metaanalyse zeigt, dass die Evidenzlage für Silber in der Wundbehandlung deutlich besser ist, als in der derzeitigen wissenschaftlichen Diskussion wahrgenommen wird. So ergeben sich bei gezieltem und zeitlich begrenztem Einsatz neben den antimikrobiellen Effekten unter anderem auch Hinweise auf eine Verbesserung der Lebensqualität sowie eine gute Kosteneffektivität.

Evidence for silver in wound care - meta-analysis of clinical studies from 2000-2015.

BACKGROUND: Given that the scientific evidence for silver in wound care is generally considered insufficient, there is uncertainty among users regarding its clinical use. MATERIAL AND METHODS: A group of experts evaluated the clinical studies on silver in wound management published from 2000-2015. RESULTS: Overall, 851 articles were identified, 173 of which were included and categorized. There were 31 randomized controlled trials (RCTs) and eight cohort studies. Twenty-eight of these studies showed statistically significant outcome parameters in support of silver. While nine of these studies investigated burn injuries, 20 addressed other indications (venous leg ulcers: 9; pressure ulcers: 3; chronic wounds: 2; diabetic foot ulcer: 1; other types of wounds: 5). In 16 studies, the primary parameter was wound healing, whereas quality of life including pain was assessed in twelve studies; cost-effectiveness, in eight studies; reduction of bacterial load, in three studies. Based on these results, a treatment algorithm for the clinical use of silver in wound care has been developed. CONCLUSIONS: The present meta-analysis shows that the evidence base for silver in wound management is significantly better than perceived in the current scientific debate. Thus, if used selectively and for a limited period of time, silver not only has antimicrobial effects but is also characterized by an improvement in quality of life and good cost-effectiveness.

Transdermal absorption of ethanol- and 1-propanol-containing hand disinfectants.

BACKGROUND AND AIMS: Ethanol- or 1-propanol-containing hand disinfectants are widely used as surgical hand antisepsis. The primary objective of this study was to investigate transdermal absorption of ethanol and 1-propanol from combination of 45% ethanol and 18% 1-propanol with skin protecting ingredients (Softa-Man®) within 1 h after application in comparison to the absorption of these alcohols from the product in the absence of the cosmetic additives. The secondary objective was to evaluate the dermal tolerability. MATERIALS AND METHODS: Following the double-blind, randomized cross-over design for this clinical trial, 20 ml of two different alcohol-containing disinfectants was applied with a 200-cm(2) gauze swab on a skin area, identical in size and location, of 14 healthy volunteers for 10 min to investigate the absorption rate of ethanol and 1-propanol. Local dermal tolerability was evaluated using a four-point erythema scale. RESULTS: No clinically relevant dermal absorption, with respect to ethanol and 1-propanol, could be observed within 1 h after application. Disinfectant-related mild local skin erythema was observed in three cases. CONCLUSION: The use of the tested formulations containing ethanol and 1-propanol can be considered as safe. The tested formulation containing skin protecting additives (Softa-Man®) does not result in more alcoholic absorption than the formulation without protective additives.

Transdermal resorption of an ethanol- and 2-propanol-containing skin disinfectant.

BACKGROUND AND AIMS: Ethanol- or 2-propanol-containing disinfectant agents are widely used in medical practice, particularly in the surgical environment. It was the primary objective of this phase I study to comparatively investigate the transdermal resorption of ethanol and 2-propanol within 1 h after dermal application of the two agents as single preparations and a commercial product containing both alcohols in combination, respectively. The secondary objective was to examine whether a mutual influence of the two alcohols in combination exists. MATERIALS AND METHODS: Following the double-blind, randomized, three-times cross-over design for this clinical trial, 20 ml of three different alcohol-containing disinfectants were applied on a 200-cm(2) gauze swab on skin areas, identical in size and location, of 14 healthy volunteers for 10 min to investigate the absorption rate of ethanol and 2-propanol with special focus on the question whether the two alcohols might influence each other's absorption rate when being applied in combination. RESULTS: No clinically relevant enhancement of dermal absorption, with respect to ethanol and 2-propanol, could be observed within 1 h after application, neither when used as single preparations, nor in combination. CONCLUSION: Therefore, the use of ethanol- and 2-propanol-containing disinfectants in the medical environment can be considered as safe.