![]() The antimicrobial efficacy of silver on antibiotic-resistant bacteria isolated fromburn wounds. Percival SL, Thomas J, Linton S, Okel T, Corum L, Slone W. Silver in health care: antimicrobial effects and safety in use. In vitro evaluation of a silver foam dressing with and without silicone adhesive againstbiofilms and a broad range of microorganisms. Christiansen C, Huniche GB, Allesen-Holm M. Managing wound exudate and promoting healing. Preparing the Wound Bed - Debridement, Bacterial Balance, andMoisture Balance. Sibbald R, Williamson D, Orsted H, Campbell K, Keast D, Krasner D, et al. Five Millennia of Wound Care Products - What is New? A Literature Review. Cost-Effective Use of Silver Dressings for the Treatment of Hard-to-HealChronic Venous Leg Ulcers. Jemec GB, Kerihuel JC, Ousey K, Lauemoller SL, Leaper DJ. The Use of Biatain Ag in Hard-to-Heal Venous Leg Ulcers:Meta-Analysis of Randomised Controlled Trials. Leaper D, Münter C, Meaume S, Scalise A, Mompó NB, Jakobsen BP, et al. Clinical and microbiologicaleffectiveness of a hydropolymer alveolar dressing with ionic silver complex and silicone adhesive. Lázaro-Martínez JL, Álvaro-Afonso FJ, García-Álvarez Y, García-Morales E, Sanz-Corbalán I, Molines-Barroso RJ. Leg Ulcers Presenting Local Signs of Infection:Interest of Biatain Argent Wound Dressing. Humbert P, Zuccarelli F, Debure C, Vendeaud Busquet F, Bressieux J-M, Bedane C, et al. Sustained silver-releasing dressing in the treatment of diabeticfoot ulcers British Journal of Nursing. Rayman G, Rayman A, Baker NR, Jurgeviciene N, Dargis V, Sulcaite R, et al. The silver-releasing foam dressing, Contreet Foam,promotes faster healing of critically colonised venous leg ulcers: a randomised, controlled trial. Jørgensen B, Price P, Andersen KE, Gottrup F, Bech-Thomsen N, Scanlon E, et al. Effect of a sustained silver-releasing dressing on ulcers with delayedhealing: the CONTOP study. Münter KC, Beele H, Russell L, Crespi A, Grochenig E, Basse P, et al. Dressings and topical agents for treating venous leg ulcers.Cochrane Database of Systematic Reviews. Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Journal of the German Society of Dermatology. Evidence for silver in wound care - meta-analysis of clinical studiesfrom 2000-2015. Dissemond J, Bottrich JG, Braunwarth H, Hilt J, Wilken P, Munter KC. A Scoping Review of the Use of Silver-impregnatedDressings for the Treatment of Chronic Wounds. Rodriguez-Arguello J, Lienhard K, Patel P, Geransar R, Somayaji R, Parsons L, et al. A review of the use of silver in wound care: facts and fallacies. Appropriate use of silver dressings in wounds. World Union of Wound Healing Societies (WUWHS). Consensus guidelines for the identification and treatment ofbiofilms in chronic nonhealing wounds. Schultz G, Bjarnsholt T, James GA, Leaper DJ, McBain AJ, Malone M, et al. International Wound Infection Institute (IWII). This suggests that while bacterial resistance to silver in wound care should be monitored, the threat of widespread resistance is low and silver containing dressings remain an extremely important tool in managing wound infection 5, 23, 24.ġ. There is a lack of substantial evidence linking bacterial resistance to silver identified in simple laboratory studies to clinical settings. Topical antiseptics, such as silver, differ from antibiotics as they have multiple sites of antimicrobial action on target cells (Figure 1) and therefore a low risk of bacterial resistance 5. The conversion of silver to these stable forms can be considered as forms of detoxification, even though the silver is not physically eliminated from the body 21.Due to the increasing focus on bacterial resistance to antibiotics, microbial resistance towards antiseptics is also a debated topic. While some permanent retention of silver from exposure to silver containing dressings cannot be ruled out, there is good biological basis to suggest that the retained silver will ultimately be in the forms of extremelystable silver selenide and silver sulphide complexes which are effectively not bioavailable. These mechanisms include natural tissue turnover that occurs particularly in the epidermis,and the host metal detoxification mechanisms involving metallothioneins and glutathione occurring in the liver and kidney, where the silver is excreted ultimately in faeces and urine. Several mechanisms exist by which the body removes excess silver. Silver has a long history of use in wound care and the safety record of the modern silver-containing wound dressings has been excellent. In the end, the bacterial cell membrane will burst, and the bacteria will be destroyed 5,21. Furthermore, silver ions will block the bacterial respiratory system and thereby destroy the energy production of the cell.
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