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Wound Infections

Wound Dressings

Leg Ulcers

Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)-coated wound dressings

02 April 2023

Articles

02 April 2023

Volume 2023 · Issue 1

ISSN (print): 2755-9599

Click to read

Abstract

Background:

Traditionally, infections are treated with antimicrobials (for example, antibiotics, antiseptics, etc), but antimicrobial resistance (AMR) has become one of the most serious health threats of the 21st century (before the emergence of COVID-19). Wounds can be a source of infection by allowing unconstrained entry of microorganisms into the body, including antimicrobialresistant bacteria. The development of new antimicrobials (particularly antibiotics) is not keeping pace with the evolution of resistant microorganisms and novel ways of addressing this problem are urgently required. One such initiative has been the development of antimicrobial stewardship (AMS) programmes, which educate healthcare workers, and control the prescribing and targeting of antimicrobials to reduce the likelihood of AMR. Of great importance has been the European Wound Management Association (EWMA) in supporting AMS by providing practical recommendations for optimising antimicrobial therapy for the treatment of wound infection. The use of wound dressings that use a physical sequestration and retention approach rather than antimicrobial agents to reduce bacterial burden offers a novel approach that supports AMS. Bacterial-binding by dressings and their physical removal, rather than active killing, minimises their damage and hence prevents the release of damaging endotoxins.

Aim:

Our objective is to highlight AMS for the promotion of the judicious use of antimicrobials and to investigate how dialkylcarbamoyl chloride (DACC)-coated dressings can support AMS goals.

Method:

MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify published articles describing data relating to AMS, and the use of a variety of wound dressings in the prevention and/or treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent and/or treat wound infection in a manner that does not kill or damage the microorganisms (for example, by actively binding and removing intact microorganisms from wounds) were then narratively reviewed.

Results:

The evidence reviewed here demonstrates that using bacterial-binding wound dressings that act in a physical manner (for example, DACC-coated dressings) as an alternative approach to preventing and/or treating infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS.

Conclusion:

Some wound dressings work via a mechanism that promotes the binding and physical uptake, sequestration and removal of intact microorganisms from the wound bed (for example, a wound dressing that uses DACC technology to successfully prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS (for example, reducing the use of antimicrobials in wound treatment regimens) by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.

An increasing number of microorganisms are acquiring antimicrobial resistance (AMR) to agents (for example, antibiotics) that are used to fight them.¹ This is an important challenge to clinical and budgetary resources worldwide.² The problem is exacerbated by the fact that development of new antibiotics is slow and in decline, and is being outpaced by the increasing resistance of these microorganisms; therefore, new strategies to tackle this problem are needed.^3–5 Progress has been made using strong infection control and targeted use of antibiotics, leading to a reduction in infections of antibiotic-resistant microorganisms.⁶ Antimicrobial stewardship (AMS) programmes have provided a systematic effort to inform, educate and persuade prescribers of antimicrobials to follow evidence-based prescribing to stem antibiotic overuse and help reduce AMR.² Nevertheless, because of AMR, and in addition to AMS programmes, new methods of treating resistant bacteria are urgently required, particularly in wound care. This has been highlighted by the European Wound Management Association (EWMA) as being a key challenge for clinicians working in the wound care field.^7,8 It has also been underlined by initiatives with which EWMA are currently involved, such as AMS podcasts,⁹ and establishing partnerships with organisations and groups that have mutual and synergistic objectives on the AMR agenda (such as the British Society for Antimicrobial Chemotherapy).⁷

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antimicrobial stewardship

antimicrobial resistance

bacterial binding

dressing

infection

ulcer

wound

wound dressings

wound infection