Leukopenia in Non-Septic Burn Patients Receiving Topical 1% Silver Sulfadiazine Cream Therapy

Fuller, Frederick W.; Engler, Peter E.

doi:10.1097/00004630-198811000-00006

Cited by 32 publications

(26 citation statements)

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“…It is easy to use and painless when applied and can be used with or without a dressing. Limited systemic toxicity with repeated daily or twice-daily application has occurred aside from the development of leukopenia (81,147). Silver sulfadiazine has excellent broad-spectrum antibacterial coverage against Pseudomonas aeruginosa and other gram-negative enteric bacteria, although some resistance has recently been reported (189,335).…”

Section: Topical Antimicrobial Therapymentioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,620

1,345

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SUMMARYBurns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.

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Section: Topical Antimicrobial Therapymentioning

confidence: 99%

Burn Wound Infections

Church

Elsayed

Reid³

et al. 2006

Clin Microbiol Rev

1,620

1,345

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“…Toxic epidermal necrolysis is commonly treated in burn facilities because of its similarity to a massive burn injury. 1 Historically, silver was not thought to be absorbed from wound care products. To date, there have been several reports of silver absorption with documented serum silver levels in almost all forms of silver-containing wound care products.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 As far back as 1966, Bader described significant silver deposition in multiple organs after use of silver nitrate. 1 And later in 1988, the silver component of SSD was reported to deposit in skin, liver, kidney, conjunctiva, cornea, and elsewhere. 1 Coombs et al reported a case series of 22 patients with burns up to 40% TBSA all treated with SSD.…”

Section: Discussionmentioning

confidence: 99%

A Case of Argyria and Acute Leukopenia Associated with the Use of an Antimicrobial Soft Silicone Foam Dressing

McCague

Joe

2016

Journal of Burn Care & Research

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Silver has had an important role in preventing burn-related infections for decades. Relatively few side effects is one factor that has led to its wide spread use. Here, the authors present the first case of argyria, acute leukopenia, and possibly acute kidney injury associated with the use of a silver-containing soft silicone foam dressing. A 56-year-old female was transferred to the burn center with an exfoliating skin condition involving 70% TBSA diagnosed as toxic epidermal necrolysis associated with trimethoprim/sulfamethoxazole. On presentation she appeared to have clinical sepsis and was started on vancomycin and piperacillin/tazobactam. Clinical sepsis resolved within several days. Initial wound care consisted of daily topical double antibiotic and 3% bismuth tribromophenate petroleum gauze. After several days, the wounds were covered with a silver-containing soft silicone foam dressing. After 7 days, the leukocyte count declined from 18,000 to 600/cm. Silver toxicity was suspected and the dressings removed. Initial serum silver level was 190 and 249 μg/L 1 week later. The leukocyte level normalized within 7 days. Over the following days and weeks, the patient's skin began to show blue-gray coloration consistent with argyria. The patient subsequently developed acute kidney injury requiring hemodialysis and multiple organ failure. Although controversy exists about the causal relationship between silver-containing dressings and leukopenia, the authors believe that this case represents a case of acute leukopenia and argyria from the use of a silver-containing soft silicone foam dressing. It may have been a contributing factor to the development of acute kidney injury as well.

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“…therapy include transient leukopenia that does not necessarily increase the incidence of infectious complications [182][183][184].…”

Section: Adverse Effectsmentioning

confidence: 99%

Use of Silver in the Prevention and Treatment of Infections: Silver Review

Politano

Campbell

Rosenberger

et al. 2013

Surgical Infections

168

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Background: The use of silver for the treatment of various maladies or to prevent the transmission of infection dates back to at least 4000 b.c.e. Medical applications are documented in the literature throughout the 17th and 18th centuries. The bactericidal activity of silver is well established. Silver nitrate was used topically throughout the 1800s for the treatment of burns, ulcerations, and infected wounds, and although its use declined after World War II and the advent of antibiotics, Fox revitalized its use in the form of silver sulfadiazine in 1968. Method: Review of the pertinent English-language literature. Results: Since Fox's work, the use of topical silver to reduce bacterial burden and promote healing has been investigated in the setting of chronic wounds and ulcers, post-operative incision dressings, blood and urinary catheter designs, endotracheal tubes, orthopedic devices, vascular prostheses, and the sewing ring of prosthetic heart valves. The beneficial effects of silver in reducing or preventing infection have been seen in the topical treatment of burns and chronic wounds and in its use as a coating for many medical devices. However, silver has been unsuccessful in certain applications, such as the Silzone heart valve. In other settings, such as orthopedic hardware coatings, its benefit remains unproved. Conclusion: Silver remains a reasonable addition to the armamentarium against infection and has relatively few side effects. However, one should weigh the benefits of silver-containing products against the known side effects and the other options available for the intended purpose when selecting the most appropriate therapy.

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Leukopenia in Non-Septic Burn Patients Receiving Topical 1% Silver Sulfadiazine Cream Therapy

Cited by 32 publications

References 0 publications

Burn Wound Infections

Burn Wound Infections

A Case of Argyria and Acute Leukopenia Associated with the Use of an Antimicrobial Soft Silicone Foam Dressing

Use of Silver in the Prevention and Treatment of Infections: Silver Review

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