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

  • Hugo C. Guthrie
    Correspondence
    Corresponding author at: c/o Dr Sarah Watts, Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom.
    Affiliations
    Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom

    Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, United Kingdom
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  • Kevin R. Martin
    Affiliations
    Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom
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  • Christopher Taylor
    Affiliations
    Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom
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  • Abigail M. Spear
    Affiliations
    Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom
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  • Rachel Whiting
    Affiliations
    Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom
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  • Sara Macildowie
    Affiliations
    Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom
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  • Jonathan C. Clasper
    Affiliations
    Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, United Kingdom
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  • Sarah A. Watts
    Affiliations
    Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom
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      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] × 102; 1.66 [0.94–2.58] × 105; 8.86 [0.00–53.35] × 104 cfu/g, respectively) and Activon Tulle group had significantly higher counts (2.82 [0.98–5.61] × 106 cfu/g) than saline soaked gauze control (7.58 [1.65–17.83] × 105 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.

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