A randomized‐controlled trial comparing cadexomer iodine and nanocrystalline silver on the healing of leg ulcers

Miller, Charne; Newall, Nelly; Kapp, Suzanne; Lewin, Gill; Karimi, Leila; Carville, Keryln; Gliddon, Terry; Santamaria, Nick

doi:10.1111/j.1524-475x.2010.00603.x

Cited by 82 publications

(65 citation statements)

References 25 publications

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“…In a study by Miller and coworkers, the effect of nano-crystalline silver on the healing of leg-ulcers was studied. The silver-dressing did not increase the overall healing rate, but was associated with quicker healing in the larger and older ulcers [93]. An extensive meta study from Storm-Versloot confirmed these findings in that most studies on silver dressings for non-healing wounds did not show significant reduction of infection when using silver sulfadiazine cream or silver dressings.…”

Section: Medical Coatings Containing Silver or Silver Nanoparticlessupporting

confidence: 67%

New Strategies in the Development of Antimicrobial Coatings: The Example of Increasing Usage of Silver and Silver Nanoparticles

2011

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Bacterial infection from medical devices is a major problem and accounts for an increasing number of deaths as well as high medical costs. Many different strategies have been developed to decrease the incidence of medical device related infection. One way to prevent infection is by modifying the surface of the devices in such a way that no bacterial adhesion can occur. This requires modification of the complete surface with, mostly, hydrophilic polymeric surface coatings. These materials are designed to be non-fouling, meaning that protein adsorption and subsequent microbial adhesion are minimized. Incorporation of antimicrobial agents in the bulk material or as a surface coating has been considered a viable alternative for systemic application of antibiotics. However, the manifestation of more and more multi-drug resistant bacterial strains restrains the use of antibiotics in a preventive strategy. The application of silver nanoparticles on the surface of medical devices has been used to prevent bacterial adhesion and subsequent biofilm formation. The nanoparticles are either deposited directly on the device surface, or applied in a polymeric surface coating. The silver is slowly released from the surface, thereby killing the bacteria present near the surface. In the last decade there has been a surplus of studies applying the concept of silver nanoparticles as an antimicrobial agent on a range of different medical devices. The main problem however is that the exact antimicrobial mechanism of silver remains unclear. Additionally, the antimicrobial efficacy of silver on OPEN ACCESSPolymers 2011, 3 341 medical devices varies to a great extent. Here we will review existing antimicrobial coating strategies and discuss the use of silver or silver nanoparticles on surfaces that are designed to prevent medical device related infections.

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Section: Medical Coatings Containing Silver or Silver Nanoparticlessupporting

confidence: 67%

New Strategies in the Development of Antimicrobial Coatings: The Example of Increasing Usage of Silver and Silver Nanoparticles

2011

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“…In addition, silver impregnated wound dressings have been shown to be efficacious on antibiotic‐resistant and silver‐resistant bacteria (18). Additionally, their usage has been associated with enhanced wound healing rates (19).…”

Section: Introductionmentioning

confidence: 99%

The antimicrobial efficacy of a silver alginate dressing against a broad spectrum of clinically relevant wound isolates

Percival

Slone

Linton

et al. 2011

International Wound Journal

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Wound dressings impregnated with silver have a role to play in aiding to reduce both the dressing and wound microbial bioburden. It is therefore imperative that antimicrobial wound dressings have efficacy on a broad range of clinical significant microorganisms. Accordingly, this study aimed to determine the antimicrobial efficacy of a silver alginate dressing against 115 wound isolates that had been isolated routinely from patients at West Virginia University Hospital. Standardised corrected zones of inhibition (CZOIs) were performed on all clinical isolates. It was found that the silver alginate dressing was able to inhibit the growth of all microorganisms tested. In particular, the silver alginate dressing inhibited the growth of Candida albicans and yeasts with CZOI of 3-11·5 mm. All meticillin-resistant Staphylococcus aureus (MRSA) strains were found to be sensitive to the silver alginate dressing with a CZOI range calculated at 3-7·8 mm. Sensitivity to the silver alginate dressing was also evident for S. aureus and vancomycin-resistant Enterococci. CZOIs of 4·25 mm were calculated for Enterococcus faecium and 9·8 mm for viridans streptococcus. The bacteria which demonstrated the highest tolerance to ionic silver included Enterobacter cloacae and Acinetobacter baumannii. Contrary to this the most responsive microorganisms to ionic silver included strains of staphylococci, viridans streptococcus and Candida albicans. No antibiotic-resistant isolates, as identified by Kirby Bauer Clinical Laboratory Standards Institute classification system, were found to be resistant to ionic silver. When a selected number of microorganisms were grown in the biofilm phenotypic state enhanced tolerance to silver was observed, compared to their non biofilm counterparts. Overall, this study has demonstrated the broad antimicrobial activity of a silver alginate dressing on wound isolates grown in the non biofilm and biofilm state. This finding is clinically relevant as both the non biofilm and biofilm phenotypic states of microorganisms are evident in wounds and therefore significant to delayed healing. Consequently, it is imperative that antimicrobial wound dressings demonstrate antimicrobial activity against microorganisms in both phenotypic states.

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“…Clinical data on the use of iodine is extensive; however, the majority of these studies focus on chronic venous leg ulcers in patient populations exclusive of diabetics (11,14–16). Diabetics display delayed healing and poor white cell function and in general have not been included in prior studies of topical antibacterials.…”

Section: Introductionmentioning

confidence: 99%

A prospective, non comparative, multicenter study to investigate the effect of cadexomer iodine on bioburden load and other wound characteristics in diabetic foot ulcers

Schwartz

Lantis

Gendics

et al. 2012

International Wound Journal

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Few studies regarding wound treatment with topical antimicrobials evaluate change in the bacterial bioburden of the wound with treatment. This study sought out to determine the in vivo effect of cadexomer iodine antibacterial dressing on diabetic foot ulcers (DFUs) that were infected or achieved a critical level of colonisation, looking specifically at wound progression in relation to bioburden. Fifteen patients corresponding to 16 total DFUs met criteria of displaying clinical signs of infection or critical colonisation and were suitable for a topical antibacterial dressing. They underwent weekly treatment for 6 weeks. Cultures were taken at week 0, 3 and 6 as appropriate. At week 6 median log10 bacterial count reduction of 1.0 was observed from baseline (p = 0·025). At week 3- a median log10 bacterial count reduction of 0.3 was observed from baseline (p = 0·049). Over the study period there was a 53.6% median reduction of the wound surface area. There were no patients that completely healed their ulcer over the 6 week study period. There was a statistically significant median reduction in the bacterial load over the 6 week period (p = 0·025) as well as 3 weeks (p = 0·049). This was accompanied by a median reduction of 53.6% in ulcer surface area and 50% in ulcer depth from baseline to final.

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A randomized‐controlled trial comparing cadexomer iodine and nanocrystalline silver on the healing of leg ulcers

Cited by 82 publications

References 25 publications

New Strategies in the Development of Antimicrobial Coatings: The Example of Increasing Usage of Silver and Silver Nanoparticles

New Strategies in the Development of Antimicrobial Coatings: The Example of Increasing Usage of Silver and Silver Nanoparticles

The antimicrobial efficacy of a silver alginate dressing against a broad spectrum of clinically relevant wound isolates

A prospective, non comparative, multicenter study to investigate the effect of cadexomer iodine on bioburden load and other wound characteristics in diabetic foot ulcers

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