A pre-clinical evaluation of silver, iodine and Manuka honey based dressings in a model of traumatic extremity wounds contaminated with Staphylococcus aureus.

Abstract

Prevention of extremity war wound infection remains a clinical challenge. Staphylococcus aureus is the most common pathogen in delayed infection. We hypothesised that choice of wound dressings may affect bacterial burden over 7 days reflecting the current practice of delayed primary closure of wounds within this timeframe. A randomised controlled trial of 3 commercially available dressings (Inadine(®) (Johnson & Johnson, NJ, USA), Acticoat(®) (Smith & Nephew, Hull, UK), Activon Tulle (Advancis Medical, Nottingham, UK)) was conducted in a rabbit model of contaminated forelimb muscle injury. A positive control group treated with antibiotics was included. Groups were compared to a saline soaked gauze control. The primary outcome was a statistically significant reduction (p < 0.05) in tissue S. aureus at 7 days post-injury. Secondary outcome measurements included bacteraemias, observational data, whole blood determination, ELISA for plasma biomarkers, PCR array analysis of wound healing gene expression and muscle/lymph node histopathology. Antibiotic, Inadine and Acticoat groups had statistically significant lower bacterial counts (mean 7.13 [95% CI 0.00-96.31]×10(2); 1.66 [0.94-2.58]×10(5); 8.86 [0.00-53.35]×10(4)cfu/g, respectively) and Activon Tulle group had significantly higher counts (2.82 [0.98-5.61]×10(6)cfu/g) than saline soaked gauze control (7.58 [1.65-17.83]×10(5)cfu/g). There were no bacteraemias or significant differences in observational data or whole blood determination. There were no significant differences in muscle/loss or pathology and lymph node cross-sectional area or morphology. There were some significant differences between treatment groups in the plasma cytokines IL-4, TNFα and MCP-1 in comparison to the control. PCR array data demonstrated more general changes in gene expression in the muscle tissue from the Activon Tulle group than the Inadine or Acticoat dressings with a limited number of genes showing significantly altered expression compared to control. This study has demonstrated that both Acticoat(®) and Inadine(®) dressings can reduce the bacteria burden in a heavily contaminated soft tissue wound and so they may offer utility in the clinical setting particularly where surgical treatment is delayed.

• Authors: Hugo C Guthrie, Kevin R Martin, Christopher Taylor, Abigail M Spear, Rachel Whiting, Sara Macildowie, Jonathan C Clasper, Sarah A Watts
• Journal: Injury (Injury) Vol. 45 Issue 8 Pg. 1171-8 (Aug 2014) ISSN: 1879-0267 [Electronic] Netherlands
• PMID: 24908627 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Iodine Compounds
• Silver Compounds

Topics

• Afghan Campaign 2001-
• Animals
• Anti-Bacterial Agents (pharmacology)
• Arm Injuries (etiology, therapy)
• Bacteremia (microbiology, prevention & control)
• Bacterial Load (drug effects)
• Bandages
• Disease Models, Animal
• Female
• Honey
• Humans
• Iodine Compounds (pharmacology)
• Leg Injuries (etiology, therapy)
• Male
• Military Medicine
• Rabbits
• Random Allocation
• Silver Compounds (pharmacology)
• Soft Tissue Injuries (drug therapy, microbiology, therapy)
• Staphylococcal Infections (drug therapy, prevention & control, therapy)
• Staphylococcus aureus (drug effects)
• United Kingdom
• Wound Healing (drug effects)
• Wound Infection (drug therapy, microbiology, therapy)