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    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

    For example, silver ions are incorporated into the bacterial cell membranes and bind to membrane proteins responsible for transport of substances in and out of the bacterial cells (Figure 1). Silver ions are also transported into the cells and will block cell division by binding to the DNA.

    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

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