Should You Use Antimicrobial Dressings On Clean, Uninfected Wounds?

Thomas Campbell, DPM, Qeena Woodard, DPM, FACFAS, and Stephanie Wu, DPM, MSc, FACFAS

Recent guidelines are disputing the notion that one should use antimicrobial dressings on wounds even when there is no evidence of infection. Accordingly, these authors take a closer look at this subject with a thorough review of the literature and an intriguing case study.

While it is well established that topical antimicrobials play an important, adjunctive role in wound infections, the role of antimicrobial dressings for clinically clean, uninfected wounds remains a topic for debate.1

   In May 2012, the Infectious Diseases Society of America (IDSA) published its most recent Clinical Practice Guideline.2 After a thorough review of all pertinent literature, the IDSA panel strongly advocated against using topical antimicrobials for most clinically uninfected wounds. At first glance, it may seem perplexing why leading experts would advise against something as innocuous as prophylaxis against biofilm formation and wound infection with the use of antimicrobial dressings. Let us take a closer look at key considerations for this reasoning.

   The top reason for recommending against antimicrobials is likely due to the lack of evidence substantiating the benefit of antimicrobial dressings over conventional wound care therapy.3-9 The research on dressings used in wound care is generally suboptimal. Several recent systematic reviews have suggested that silver-containing dressings and topical silver were neither better nor worse than control dressings in preventing wound infection and promoting healing.10-13

   One such review was a 2010 Cochrane Review, which evaluated 26 trials involving 2,066 participants and compared silver-containing dressings against dressings without silver.13 Six of the trials focused on a mixture of different types of wounds while the other 20 trials concentrated on burn wounds. The authors of the review deemed that the trials were of poor quality with the silver dressings having no impact on infection. Furthermore, the review found the silver-containing products increased the healing time of partial-thickness burn wounds.

   Although another Cochrane Review noted some evidence to support the use of cadexomer iodine, most of the trials were small and many had methodological problems such as poor baseline comparability between groups, and failure to use (or report) true randomization.14 The use of honey for treating wounds was the subject of a 2008 Cochrane systematic review.15 On the basis of data from research trials that met the inclusion criteria, the authors concluded that honey may reduce the healing time for mild to moderate superficial and partial thickness burns, but did not significantly hasten leg ulcer healing. The systematic review found insufficient evidence to guide clinical practice for other uses.

   Most clinical practices mirror these ambiguous findings. Antimicrobial dressings such as silver and cadexomer iodine-impregnated wound products are in common use in daily practice but despite the current wide use of antimicrobial dressings, very few, if any, clinicians can report a 0 percent infection rate or 100 percent healing rate because of the use of antimicrobial dressings.

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