A Retrospective Data Analysis of Antimicrobial Dressing Usage in 3,084 Patients

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Caroline E. Fife, MD; Marissa J. Carter, PhD, MA; David Walker, CHT; and Brett Thomson, BS

Abstract: Knowledge about practice patterns and optimal usage criteria for topical antimicrobial dressings is limited. A retrospective data analysis was conducted to evaluate: 1) the length of time these dressings are applied in a typical episode of wound care, 2) the number of episodes of antimicrobial dressing use, and 3) whether antimicrobial dressings are applied in consideration of signs and symptoms of infection. Wound care registry data from a level-4 electronic medical record were analyzed, providing information on 3,084 patients older than 17 years seen from July 2003 through December 2008 in 26 hospital-based, outpatient wound centers in 14 states. The 5,541 recorded wounds ranged in size from 0.3 to 225 cm2. One antimicrobial dressing use episode was recorded for 71% of wounds (4.7% had four or more). Mean treatment episode length was 32.5 days (median 21 days). Clinicians used these dressings for a longer period of time if patients had multiple comorbidities (P = .0001), a refractory wound (P <.00001), or were prescribed oral antibiotics (P <.0002); first dressing use was more common in wounds with signs and symptoms of infection (P <.00001). During an average of 16 (median 10) visits and a follow-up time of 269 days, 61.4% of wounds healed (range 42.2% for flaps or grafts to 67.9% for surgical wounds of all 5,541 wounds). Antimicrobial dressing use for 2 to 4 weeks was associated with a higher proportion of healed wounds, but in wounds that healed, longer dressing use was associated with a longer healing time. The practice pattern observed suggests that antimicrobial dressing usage generally is based on patient and wound assessment variables but prospective studies are needed to develop optimal guidelines of care.



Potential Conflicts of Interest: Dr. Fife has received speaker honoraria from KCI® (San Antonio, TX) and Organogenesis, Inc (Canton, MA) and is a major shareholder in Intellicure, Inc.™ (The Woodlands, TX). Dr. Carter has received speaker honoraria from Hollister Wound Care, LLC (Libertyville, IL). Mr. Walker owns stock in and Mr. Thomson is employed by Intellicure, Inc.



Please address correspondence to: Caroline E. Fife, MD, Department of Medicine, Division of Cardiology, The University of Texas Health Science Center, 6431 Fannin, MSB, Houston, TX 77030; email: Caroline.E.Fife@uth.tmc.edu.



     In recent years, the use of antimicrobial dressings that do not contain antibiotics — whether ointments, gels, or impregnated dressings — has increased.1-8 Preclinical studies suggest that when active agents, such as ionic silver, can be released over a period of time at steady concentrations, the likelihood of cytotoxicity is decreased, reducing possible impairment of wound healing while achieving a more constant antimicrobial effect to reduce bacterial growth.1,2 Iodophors (eg, povidone-iodine and cadexomer-iodine, ionic silver, chlorhexidine, and polyhexamethylene-biguanide) are some of the most commonly used antimicrobials,3-8 but the evidence for their efficacy in terms of improving wound healing is limited. Specifically, the sample size of many relevant randomized controlled trials (RCTs) has been small (<140 patients), follow-up is short (≤6 weeks), and evidence about some wound-healing outcomes, such as complete wound healing or time to heal, is frequently lacking although results of recent meta-analyses9,10 of silver-impregnated dressings suggest they improve wound healing and reduce odor, wound pain, and exudate compared to other protocols of care.

References: 

1. Fong J, Wood F. Nanocrystalline silver dressings in wound management: A review. Int J Nanomedicine. 2006;1(4):441–449.
2. Agarwal A, Weis TL, Schurr MJ, et al. Surfaces modified with nanometer-thick silver-impregnated polymeric films that kill bacteria but support growth of mammalian cells. Biomaterials. 2010;31(4):680–690.
3. White RJ, Cutting K, Kingsley A. Topical antimicrobials in the control of wound bioburden. Ostomy Wound Manage. 2006;52(8):26–58.
4. Khan MN, Naqvi AH. Antiseptics, iodine, povidone iodine and traumatic wound cleansing. J Tissue Viability. 2006;16(4):6–10.
5. Leaper DJ, Durani P. Topical antimicrobial therapy of chronic wounds healing by secondary intention using iodine products. Int Wound J. 2008;5(2):361–368.
6. Leaper DJ. Silver dressings: their role in wound management. Int Wound J. 2006;3(4):282–294.
7. Milstone AM, Passaretti CL, Perl TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis. 2008;46(2):274–281.
8. Landis SJ. Chronic wound infection and antimicrobial use. Adv Skin Wound Care. 2008;21(11):531–542.
9. Carter MJ, Tingley-Kelley K, Warriner RA III. Silver treatments and silver-impregnated dressings for the healing of leg wounds and ulcers: a systematic review and meta-analysis. J Am Acad Dermatol. 2010: In press.
10. Lo SF, Chang CJ, Hu WY, Hayter M, Chang YT. The effectiveness of silver-releasing dressings in the management of non-healing chronic wounds: a meta-analysis. J Clin Nurs. 2009;18(5):716–728.
11. Sundberg J, Meller R. A retrospective review of the use of cadexomer iodine in the treatment of chronic wounds. Wounds. 1997;9(3):68–86.
12. Hermans MH, Bolton L. How do we manage critically colonized wounds? Rehabil Nurs. 2004;29(6):187–194.
13. Verdú Soriano J, Rueda López J, Martínez Cuervo F, Soldevilla Agreda J. Effects of an activated charcoal silver dressing on chronic wounds with no clinical signs of infection. J Wound Care. 2004;13(10):419–423.
14. Akiyama H, Oono T, Saito M, Iwatsuki K. Assessment of cadexomer iodine against Staphylococcus aureus biofilm in vivo and in vitro using confocal laser scanning microscopy. J Dermatol. 2004;31(7):529–534.
15. Mertz PM, Oliveira-Gandia MF, Davis SC. The evaluation of a cadexomer iodine wound dressing on methicillin-resistant Staphylococcus aureus (MRSA) in acute wounds. Dermatol Surg. 1999;25(2):89–93.
16. Danielsen L, Cherry GW, Harding K, Rollman O. Cadexomer iodine in ulcers colonised by Pseudomonas aeruginosa. J Wound Care. 1997;6(4):169–172.
17. Hauser J, Rossbach O, Vogt PM, et al. [Efficacy of treatment with Repithel and Jelonet in comparison to treatment with Jelonet alone - a randomized clinical trial in patients receiving meshed skin grafts] Zentralbl Chir. 2006;131(4):315–321.
18. Howell-Jones RS, Wilson MJ, Hill KE, Howard AJ, Price PE, Thomas DW. A review of the microbiology, antibiotic usage and resistance in chronic skin wounds. J Antimicrob Chemother. 2005;55(2):143–149.
19. Stotts NA, Hunt TK. Managing bacterial colonization and infection. Clin Geriatr Med. 1997;13(3):565–573.
20. Cutting KF, Harding KG. Criteria for identifying wound infection. J Wound Care. 1994;3(4):198–201.
21. Gardner SE, Frantz RA, Doebbeling BN. The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Wound Repair Regen. 2001;9(3):178–186.
22. Sibbald RG, Woo K, Ayello EA. Increased bacterial burden and infection: the story of NERDs and STONES. Adv Skin Wound Care. 2006;19(8):447–463.
23. Woo KY, Sibbald RD. A cross-sectional validation study of using NERDS and STONEES to assess bacterial burden. Ostomy Wound Manage. 2009;55(8):40–48.
24. Templeton S. Management of chronic wounds: the role of silver-containing dressings. Primary Intention. 2005;13(4):170–179.
25. Nabuurs-Franssen MH, Sleegers R, Huijberts MS, et al. Total contact casting of the diabetic foot in daily practice: a prospective follow-up study. Diabetes Care. 2005;28(2):243-247.
26. Robson MC, Hill DP, Woodske ME, Steed DL. Wound healing trajectories as predictors of effectiveness of therapeutic agents. Arch Surg. 2000;135(7):773-777.
27. Blair SD, Wright DD, Backhouse CM, Riddle E, McCollum CN. Sustained compression and healing of chronic venous ulcers. BMJ. 1988;297(6657):1159-1161.
28. Bolton L, McNees P, van Rijswijk L, et al. Wound-healing outcomes using standardized assessment and care in clinical practice. J WOCN. 2004;31(2):65-71.
29. Thomas GW, Rael LT, Bar-Or R, et al. Mechanisms of delayed wound healing by commonly used antiseptics. J Trauma. 2009;66(1):82-91.
30. Zhou LH, Nahm WK, Badiavas E, Yufit T, Falanga V. Slow release iodine preparation and wound healing: in vitro effects consistent with lack of in vivo toxicity in human chronic wounds. Br J Dermatol. 2002;146(3):365-374.
31. Dimakakos E, Katsenis K, Kalemikerakis J, et al. Infected venous leg ulcers: management with silver-releasing foam dressing. Wounds 2009;21:4-8.
32. Fife CE, Carter MJ, Walker D. Why is it so hard to do the right thing in wound care? Wound Repair Regen. 2010; Feb 16 [epub ahead of print].






























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