Find your Coloplast country website

Silver. A powerful weapon against microbes

Silver is a well-documented antimicrobial, that has been shown to kill bacteria, fungi and certain viruses. It is the positively charged silver ions (Ag+) that possess the antimicrobial effect21, 22. Silver ions target microorganisms through several different modes of action.

Effects of silver ions on bacteria.

Figure 1

Furthermore, silver ions will block the bacterial respiratory system and thereby destroy the energy production of the cell. In the end, the bacterial cell membrane will burst, and the bacteria will be destroyed 5,21.

Silver has a long history of use in wound care and the safety record of the modern silver-containing wound dressings has been excellent. Several mechanisms exist by which the body removes excess silver. 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. 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. 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. 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. There is a lack of substantial evidence linking bacterial resistance to silver identified in simple laboratory studies to clinical settings. 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.

Reference list

See full list of references

1. International Wound Infection Institute (IWII). Wound infection in clinical practice. Wounds International. 2016.

2. Coloplast A/S, ReD associates. Data on file. 2014.

3. Schultz G, Bjarnsholt T, James GA, Leaper DJ, McBain AJ, Malone M, et al. Consensus guidelines for the identification and treatment ofbiofilms in chronic nonhealing wounds. Wound Repair and Regeneration. 2017;25(5):744-57.

4. World Union of Wound Healing Societies (WUWHS). Florence Congress, Position Document. Management of biofilm. 2016.

5. Appropriate use of silver dressings in wounds. An expert working group consensus. International consensus. London; 2012.

6. Lansdown AB. A review of the use of silver in wound care: facts and fallacies. British Journal of Nursing. 2004;13(6):s6-19.

7. Rodriguez-Arguello J, Lienhard K, Patel P, Geransar R, Somayaji R, Parsons L, et al. A Scoping Review of the Use of Silver-impregnatedDressings for the Treatment of Chronic Wounds. Ostomy Wound Management. 2018;64(3):14-31.

8. Dissemond J, Bottrich JG, Braunwarth H, Hilt J, Wilken P, Munter KC. Evidence for silver in wound care - meta-analysis of clinical studiesfrom 2000-2015. Journal of the German Society of Dermatology. 2017;15(5):524-35.

9. Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers.Cochrane Database of Systematic Reviews. 2018(6):1-289.

10. Münter KC, Beele H, Russell L, Crespi A, Grochenig E, Basse P, et al. Effect of a sustained silver-releasing dressing on ulcers with delayedhealing: the CONTOP study. Journal of wound care. 2006;15(5):199-206.

11. Jørgensen B, Price P, Andersen KE, Gottrup F, Bech-Thomsen N, Scanlon E, et al. The silver-releasing foam dressing, Contreet Foam,promotes faster healing of critically colonised venous leg ulcers: a randomised, controlled trial. International wound journal. 2005;2(1):64-73.

12. Rayman G, Rayman A, Baker NR, Jurgeviciene N, Dargis V, Sulcaite R, et al. Sustained silver-releasing dressing in the treatment of diabeticfoot ulcers British Journal of Nursing. 2004;14(2);109-14.

13. Humbert P, Zuccarelli F, Debure C, Vendeaud Busquet F, Bressieux J-M, Bedane C, et al. Leg Ulcers Presenting Local Signs of Infection:Interest of Biatain Argent Wound Dressing. Journal des Plaies et Cicatrisations. 2006;52(9):41-7.

14. Lázaro-Martínez JL, Álvaro-Afonso FJ, García-Álvarez Y, García-Morales E, Sanz-Corbalán I, Molines-Barroso RJ. Clinical and microbiologicaleffectiveness of a hydropolymer alveolar dressing with ionic silver complex and silicone adhesive. Poster, EWMA(EPP021); 2018.

15. Leaper D, Münter C, Meaume S, Scalise A, Mompó NB, Jakobsen BP, et al. The Use of Biatain Ag in Hard-to-Heal Venous Leg Ulcers:Meta-Analysis of Randomised Controlled Trials. PLoS ONE. 2013;8(7):e67083.

16. Jemec GB, Kerihuel JC, Ousey K, Lauemoller SL, Leaper DJ. Cost-Effective Use of Silver Dressings for the Treatment of Hard-to-HealChronic Venous Leg Ulcers. Plos One. 2014;9(6):e100582.

17. Mouës C, Heule F, Legerstee R, Hovius S. Five Millennia of Wound Care Products - What is New? A Literature Review. Ostomy WoundManagement. 2009;55(3):16-8.

18. Sibbald R, Williamson D, Orsted H, Campbell K, Keast D, Krasner D, et al. Preparing the Wound Bed - Debridement, Bacterial Balance, andMoisture Balance. Ostomy Wound Management. 2000;46(11):14-35.

19. Adderley UJ. Managing wound exudate and promoting healing. British Journal of Community Nursing. 2010;15(3):15-20.

20. Christiansen C, Huniche GB, Allesen-Holm M. In vitro evaluation of a silver foam dressing with and without silicone adhesive againstbiofilms and a broad range of microorganisms. Poster, EWMA(EPP025); 2018.

21. Lansdown AB. Silver in health care: antimicrobial effects and safety in use. Current Problems in Dermatology. 2006;33:17-34.

22. Percival SL, Thomas J, Linton S, Okel T, Corum L, Slone W. The antimicrobial efficacy of silver on antibiotic-resistant bacteria isolated fromburn wounds. International wound journal. 2012;9(5):488-93.

23. Böttrich JG, Brill FHH, Dissemond J, Steinmann J, Münter KC, Schümmelfeder F, et al. A Systematic Review of the Risk of BacterialResistance to Silver. Poster, EWMA; 2018.

24. Percival SL, Woods E, Nutekpor M, Bowler P, Radford A, Cochrane C. Prevalence of Silver Resistance in Bacteria Isolated from DiabeticFoot Ulcers and Efficacy of Silver-Containing Wound Dressings. Ostomy Wound Management. 2008;54(3):30-40.

25. Kostenko V, Lyczak J, Turner K, Martinuzzi RJ. Impact of Silver-Containing Wound Dressings on Bacterial Biofilm Viability and Susceptibilityto Antibiotics during Prolonged Treatment. Antimicrobial Agents and Chemotherapy. 2010;54(12):5120-31.

26. Burger C, Lemoult S, Andersen MB. Silver release profile and antibacterial effect of a new silver foam dressing with silicone adhesive.Poster, EWMA(EPP025); 2018.

27. Malone M, Bjarnsholt T, McBain AJ, James GA, Stoodley P, Leaper D, et al. The prevalence of biofilms in chronic wounds: a systematicreview and meta-analysis of published data. Journal of wound care. 2017;26(1):20-5.

28. Bjarnsholt T. The Role of Bacterial Biofilms in Chronic Infections. Acta pathologica, microbiologica, et immunologica Scandinavica.2013;121(s136):1-58.

29. Costerton JW. Bacterial Biofilms: A Common Cause of Persistent Infections. Science. 1999;284(5418):1318-22.

30. Crone S, Garde C, Bjarnsholt T, Alhede M. A novel in vitro wound biofilm model used to evaluate low-frequency ultrasonic-assisted wounddebridement. Journal of wound care. 2015;24(2):64-72.

31. Bessa LJ, Fazii P, Di Giulio M, Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarksabout wound infection. International wound journal. 2013;12(1):47-52.

32. Yin HQ, Langford R, Burrell RE. Comparative Evaluation of the Antimicrobial Activity of ACTICOAT Antimicrobial Barrier Dressing. Journalof Burn Care & Rehabilitation. 1999;20(3):195-200.

33. ASTM E2149-13a, Standard Test Method for Determining the Antimicrobial Activity of Antimicrobial Agents Under Dynamic ContactConditions. ASTM International. 2013.

34. prEN16756 (draft). Antimicrobial wound dressings – Requirements and test methods. 2014.

35. Howell-Jones RS, Wilson MJ, Hill KE, Howard AJ, Price PE, Thomas DW. A review of the microbiology, antibiotic usage and resistance inchronic skin wounds. Journal of Antimicrobial Chemotherapy. 2005;55(2):143-9.

36. Bowler PG, Duerden BI, Armstrong DG. Wound Microbiology and Associated Approaches to Wound Management. Clinical MicrobiologyReviews. 2001;14(2):244-69.

37. Daeschlein G. Antimicrobial and antiseptic strategies in wound management. International wound journal. 2013;10 Suppl 1:9-14.

38. Thomas S. Laboratory findings on the exudate-handling capabilities of cavity foam and foam-film dressings. Journal of wound care.2010;19(5):192-9.

39. White R, Cutting KF. Modern exudate management: a review of wound treatments. Poster, EWMA(EPP025); 2018.

40. Romanelli M, Vowden K, Weir D. Exudate management made easy. Wounds International. 2010;1(2):1-6.

41. Andersen MB. Comparison of 24 hours fluid handling and absorption under pressure between four wound dressings with Ag and siliconeadhesive. EWMA(EP296); 2016.

42. Baños AM, Nogueras FI, Palomar LF. Clinical evaluation of a silver dressing in the treatment of infected and colonized ulcers. Revista deenfermería. 2008;31(3):42-8.

43. Senet P, Bause R, Jorgensen B, Fogh K. Clinical efficacy of a silver-releasing foam dressing in venous leg ulcer healing: a randomisedcontrolled trial. International wound journal. 2014;11(6):649-55.

44. Flanagan M. Wound measurement: can it help us to monitor progression to healing? Journal of wound care. 2003;12(5):189-94.

View desktop version