Risk and clinical impact of bacterial resistance/susceptibility to silver-based wound dressings: a systematic review

Objective: To perform a systematic review of the literature on bacterial resistance, tolerance and susceptibility of silver within the context of wound therapy using silver-based dressings. Methods: A literature search was carried out using PubMed, Embase and Cochrane Library databases, the focus was whether results from microbiological experimental in vitro tests with reference strains and clinical wound isolates are reflected in clinical practice with regards to their 'resistance' profiles, comparable with those observed for antibiotics. The search results were allocated to six categories: resistance and resistance mechanism, in vitro tests with standard strains and wound isolates, prevalence and incidence, impact on clinical practice and impact on antibiotic therapy as well as reviews, expert opinions and consensus. Results: Based on all findings of the literature, it cannot be confirmed that a related clinical resistance to silver-ions in silver-based dressings has clinical impact, although endogenous and exogenous genetic resistance patterns have been described and intensively investigated. A translation of these genetic resistance-expression structures to phenotypic appearances, similar to those known for antibiotics, has not been demonstrated for silver in the literature. Conclusion: It can be concluded that there is no definitive evidence available and further studies should be conducted. Declaration of interest: JG Bottrich, H Braunwarth, F Schummelfeder and P Wilken are employees of B. Braun Melsungen AG, Coloplast GmbH, Smith + Nephew GmbH and URGO GmbH, respectively. Under a scheme of notified and approved outside business activities, J Dissemond received consulting fees from 4M, Beiersdorf, B. Braun, BSN, Coloplast, Convatec, Draco, Engelhard, Flen Pharma, Hartmann, Lohmann & Rauscher, Medi, Serag-Wiessner and Urgo. KC Munter received consulting fees from URGO, Coloplast and Smith + Nephew. J Steinmann and H Brill have no conflict of interest to declare.