Resistance to the biocidal activity of silver in burn wound dressings - is it a problem?

Severe burn injuries are commonly associated with significant mortality and morbidity. A burn injury of 30% of the body surface area is associated with generalised depression of the immune system(1). Survival from these injuries is due to many factors, including the control of bacterial colonisation and infections leading to sepsis. Many of the organisms commonly recovered from infected patients in the burn ICU are members of the ESKAPE2 (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) group of pathogens recognised as the most challenging bacteria carrying multidrug (MDR) resistance facing clinicians today(2-4). Efforts to control wound burn sepsis is routinely managed by the topical application of dressings containing silver. There is concern that some microorganisms can develop resistance to the biocidal activity of silver and that this may increase due to the widespread commercial use of silver(5).