Silver Toxicity With the Use of Silver-Impregnated Dressing and Wound Vacuum-Assisted Closure in an Immunocompromised Patient

Abstract

Silver-containing topical agents are used to help prevent infectious complications in wound therapy. Toxicity from topical silver agent exposure was initially reported in 1975 and was clinically characterized by granulocytopenia. Currently, the data regarding potential toxicity associated with silver-impregnated devices are limited. A 23-year-old patient receiving chemotherapy for acute lymphoblastic leukemia presented with necrotizing fasciitis of the abdominal wall and scrotum from a Crohn disease-related psoas-enteric fistula. Surgical debridement of the soft-tissue and abdominal musculature was performed to the peritoneum. Silver-containing foam sponges and wound vacuumassisted closure were applied directly to the peritoneum 2 weeks after initial debridement. Subsequently, the patient developed leukopenia, and workup revealed the serum silver level was 4 times normal level. Silver-impregnated sponges were discontinued and silver-free sponges and wound vacuum-assisted closure therapy resumed, followed by leukopenia resolution. Silver toxicity associated with routine application of silver-impregnated sponges has not been previously reported.

Effects of wound dressings containing silver on skin and immune cells

“…The high content of glycerol in Ia could have increased SSD penetration in our experiments. Several studies have already shown that silver (as Ag 0 or Ag + ) can penetrate through damaged skin and reach circulation in vivo [22][23][24] or ex vivo 25 . In addition, Larese et al observed the detectable penetration of silver from AgNP applied on intact ex vivo human skin 26 .…”

Smart Wound Dressings for Diabetic Chronic Wounds

“…Other studies have indicated that intravenous options, such as imipenem, gentamicin, vancomycin, teicoplanin, rifampicin, or lenozoid can be effective [ 19 , 21 ]. Silver nanoparticles and many other hard metals, such as zinc, copper, and arsenic also contain antimicrobial properties, but must be carefully monitored for the development of a metal toxicity [ 22 , 23 ]. Revascularization can be made possible through angioplasty, thrombolysis, and most commonly, bypass surgery [ 6 ].…”

“…They also showed that impedance measurements inhibited the growth of bacteria, due to the deposit of Ag ions in the culture [ 110 ]. Ag is a widely acceptable antimicrobial molecule and the use of Ag in wound dressings has been demonstrated clinically [ 23 ].…”

Smart Wound Dressings for Diabetic Chronic Wounds

“…bacteria, due to the deposit of Ag ions in the culture [99]. Ag is a widely acceptable antimicrobial molecule and the use of Ag in wound dressings has been demonstrated clinically [20]. Swisher et al designed a flexible, electronic device that non-invasively detects ulcers via impedance spectroscopy across a flexible electrode array in a rat model [100] They used inkjet printing to create gold-plated electrodes on a polyethylene naphthalene substrate where they used a LCR meter to detect the impedance between two locations on the array.…”