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RESEARCH DATA

COMPARATIVE EVALUATION OF THE ANTIMICROBIAL ACTIVITY OF ACTICOAT* ANTIMICROBIAL BARRIER DRESSING

H.Q. Yin, MD, PhD, R. Langford, BSc, and R. E. Burrell, PhD
Fort Saskatchewan, Alberta, Canada

This study evaluated the antimicrobial activity of ACTICOAT Antimicrobial Barrier Dressing (Westaim Biomedical Corp, Fort Saskatchewan, Alberta, Canada), a silver-coated wound dressing, and compared it with silver nitrate, silver sulfadiazine, and mafenide acetate. The minimum inhibitory concentrations (MIC), minimum bactericidal concentrations (MBC), zone of inhibition, and killing curves were determined with 5 clinically relevant bacteria. The data indicate that ACTICOAT silver had the lowest MIC and MBC and generated similar zones of inhibition to silver nitrate and silver sulfadiazine. Viable bacteria were undetectable 30 minutes after inoculation with the dressing, whereas it took 2 to 4 hours for silver nitrate and silver sulfadiazine to achieve the same result. Mafenide acetate generated the biggest zones of inhibition, but it had the highest MICs and MBCs, and a significant number of bacteria still survived after 6 hours of treatment The results suggest that ACTICOAT Antimicrobial Barrtier Dressing has better anti-microbial performance than either of the existing silver-based products. ACTICOAT dressing killed the bacteria that were tested much faster, which is a very important characteristic for a wound dressing acting as a barrier to invasive infection to have. The study also suggests that a single susceptibility test such as a MIC or zone of inhibition test does not provide a comprehensive profile of antimicrobial activity of a topical antimicrobial agent or dressing. A combination of tests is desirable. (J Burn Care Rehab 1999;20:195-200)

WOUND MANAGEMENT IN AN ERA OF INCREASING BACTERIAL ANTIBIOTIC RESISTANCE: A ROLE FOR TOPICAL SILVER TREATMENT

J. Barry Wright PhD, Kan Lam, Robert E. Burrell, PhD

Antibiotic-resistant bacteria represent an increasing concern in wound infections. Wound colonization with these organisms normally results in aggressive management of the wound complicated by a greatly limited choice of therapeutic antibiotics. Silver and other noble metals are recognized as potential allies in combating these organisms in wounds. 

Three types of topical silver applications were tested to determine their bacterial efficacies against clinical isolates of antibiotic-resistant organisms. The silver-based applications represent 3 methods of applying silver to wounds: as a liquid (silver nitrate), incorporated in a cream (silver sulfadiazine) and as a dressing coating (silver-coated dressings). The reduction in the viable bacterial population recovered from test articles after exposure to silver provided a comparative measure of the bactericidal efficacies of these silver applications. 

All of the products demonstrated an ability to reduce the number of viable bacteria. However, the methods varied in their efficacy against antibiotic-resistant bacteria, with the silver-coated dressing being the most efficacious and silver nitrate the least efficacious. 

Silver was demonstrated to be effective at killing the antibiotic-resistant strains tested. The silver-coated dressing was particularly rapid at killing the tested bacteria and was effective against a broader range of bacteria. Silver may be a useful prophylactic or therapeutic agent for the prevention for wound colonization by organisms that impeded healing, including antibiotic-resistant bacteria. (AJIC Am J Infect Control 1998:26:572-7).

A MATCHED-PAIR, RANDOMIZED STUDY EVALUATING THE EFFICACY AND SAFETY OF ACTICOAT* SILVER-COATED DRESSING FOR THE TREATMENT OF BURN WOUNDS

Edward E. Tredget, MD, MSc, Heather A. Shankowsky, RN, Audrey Groenveld, MD, and Robert Burrell, PhD

A new silver-coating technology was developed to prevent wound adhesion, limit nosocomial infection, control bacterial growth, and facilitate burn wound care through a silver-coated dressing material. For the purposes of this article, ACTICOAT (Westaim Biomedical Inc., Fort Saskatchawan, Alberta, Canada) silver-coated dressing was used. After in vitro and in vivo studies, a randomized, prospective clinical study was performed to assess the efficacy and case of use of Acticoat dressing as compared with the efficacy and case of our institution's standard burn wound care. Thirty burn patients with symmetric wounds were randomized to be treated with either 0.5% silver nitrate solution or Acticoat silver-coated dressing. The dressing was evaluated on the basis of overall patient comfort, case of use for the wound care provider, and level of antimicrobial effectiveness. Wound pain was rated by the patient using a visual analog scale during dressing removal, application, and 2 hours after application. Ease of use was rated by the nurse providing wound care. Antimicrobial effectiveness was evaluated by quantitative burn wound biopsies performed before and at the end of treatment. Patients found dressing removal less painful with Acticoat than with silver nitrate, but they found the pain to be comparable during application and 2 hours after application. According to the nurses, there was no statistically significant difference in the ease of use. The frequency of burn wound sepsis (>105 organisms per gram of tissue) was less in Acticoat-treated wounds than in those treated with silver nitrate (5 vs 16). Secondary bacteremias arising from infected burn wounds were also less frequent with Acticoat than with silver nitrate-treated wounds (1 vs 5). Acticoat dressing offers a new form of dressing for the burn wound, but it requires further investigation with greater numbers of patients in a larger number of centers and in different phases of burn wound care.

(J Burn Care Rehabilitation 1998 19:531-537)

Comparison of silver release and antimicrobial properties of silver delivery (ACTICOAT) versus a silver membrane (Arglaes)

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Comparison of Silver Delivery (ACTICOAT) and Silver film (Arglaes)

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Conclusion: Both the amount of silver released and the antibacterial properties are significantly greater with the ACTICOAT. 

EFFICACY OF SILVER-COATED DRESSINGS AS BACTERIAL BARRIERS IN A RODENT BURN SEPSIS MODEL Robert E. Burrell, , John P. Heggers, G. James Davis , J.B. Wright,

This study was designed to assess the efficacy of silver-coated dressings in preventing pseudomonas aeruginosa-related burn wound mortality in rats. Infection by P. aeruginosa remains a significant cause of burn wound sepsis. Antibiotic therapy has not been as successful as anticipated in controlling these organisms, prolmpting continued research into other treatment modalities, including topical agents, to prevent or reduce infection. Using a modified Walker-Mason technique, burn wounds were induced on rats by exposing an area of dorsal skin to boiling water for 12 seconds. Burn sites were covered with vehicle dressings, with vehicle dressings saturated with AgNO3 or with silver-coated dressings, and inoculated with P. aeruginosa. A Burn Control group and Infection Control group were also included. Mortality was monitored daily and body weight gain was assessed at several intervals throughout the 15-day post-wounding study. Mean percent survival of rats receiving the silver-coated dressings was 85 percent compared to five percent in the Infection Control group and zero percent in the Silver Nitrate Dressing and Dressing Control groups. Rats in all infected groups lost weight during the first three days, but mean body weight loss was significantly greater in AgNO3 and Dressing Control groups than in Silver-Coated Dressing groups. Mean body weights of animals in the Silver-Coated Dressing group were comparable to Burn Control rats at Day 15. The use of the dressings coated with nanocrystaline silver significantly improved rat survival in this animal model. 

(WOUNDS 1999;11(4):64-71)

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EFFICACY OF TOPICAL SILVER AGAINST FUNGAL BURN WOUND PATHOGENS
J.B. Wright, PhD, K. Lam, BSc, D. Hansen, CET, R.E. Burrell, PhD
Fort Saskatchewan, Alberta, Canada

Fungal infections of burn wounds have become an important cause of burn-associated morbidity and mortality. The nature of fungal infections dictates aggressive treatment to minimize the morbidity associated with these infections. Persons with large total body surface area burns are particularly susceptible to fungal infections and are treated in such a manner as to minimize their risk of infection. Methods: This study examined the in vitro fungicidal efficacy of a variety of different topical agents. By placing fungal inocula in contact with mafenide acetate, silver nitrate, silver sulfadiazine, and a nanocrystalline silver-coated dressing, we determined the kill kinetics of these topical agents agains a spectrum of common burn wound fungal pathogens. Results: The topical antimicrobials that were tested demonstrated varying degrees of efficacy against these pathogens. Conclusion: The nanocrystalline silver-based dressing provided the fastest and broadest-spectrum fungicidal activity and may make it a good candidate for use to minimize the potential of fungal infection, thereby reducing complications that delay wound healing. (AJIC Am J Infect Control 1999:27;344-50)