title: Comparison of PHMB-containing dressing and silver dressings in patients with critically colonised or locally infected wounds.
abstract: OBJECTIVE
  This study compares treatment with a polihexanide-containing biocellulose wound dressing (BWD+PHMB) versus the best local standard of silver dressings (Ag) in painful, critically colonised (wounds-at-risk) or locally-infected wounds.
  
  
  METHODS
  Patients with wounds of various aetiologies, a baseline VAS pain score >4 and a semi-quantitative bacterial load of ++ or higher were randomly allocated to receive treatment with either BWD+PHMB or Ag. Patients with systemic infections and/or using systemic antibiotics were excluded. The primary endpoint, patient-reported pain (VAS total pain, including the sub-scores pain at night, during the day, before, and 15min after dressing changes), was compared between treatment groups and scored on days 0, 1, 3, 7, 14, 21 and 28. Secondary outcomes of bacterial load, wound bed and periwound skin condition, quality of life and dressing handling were assessed at the same visits.
  
  
  RESULTS
  Thirty-eight patients (BWD+PHMB, n=21 [24 wounds]; Ag, n=17 [18 wounds]) were included in the analyses. Baseline variables showed no significant differences. Wound pain was reduced significantly in both groups, with a better pain reduction noted for BWD+ PHMB (p<0.001) before dressing changes. Compared with Ag, in the BWD+PHMB group critical colonisation and local wound infection had been reduced significantly faster and better (p<0.001) over the 28-day study period. Improved quality of life, good tolerability and no adverse events were demonstrated for both groups.
  
  
  CONCLUSIONS
  Both BWD+PHMB and AG were effective in reducing pain and bacterial burden. However, that BWD+PHMB was significantly faster and better in removing the critical bacterial load, makes this dressing an attractive therapeutic option to treat critically colonised and locally-infected wounds.
authors.affiliation: Department of Surgery, Salmaniya Medical Centre, Arabian Gulf University, Manama, Bahrain.
authors.forename: T
authors.initials: T
authors.lastname: Eberlein
authors.forename: G
authors.initials: G
authors.lastname: Haemmerle
authors.forename: M
authors.initials: M
authors.lastname: Signer
authors.forename: U
authors.initials: U
authors.lastname: Gruber Moesenbacher
authors.forename: J
authors.initials: J
authors.lastname: Traber
authors.forename: M
authors.initials: M
authors.lastname: Mittlboeck
authors.forename: M
authors.initials: M
authors.lastname: Abel
authors.forename: R
authors.initials: R
authors.lastname: Strohal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000628:therapy*; D058491:Bacterial Load; D001458:Bandages / Q000009:adverse effects; D001645:Biguanides / Q000009:adverse effects / Q000627:therapeutic use*; D002482:Cellulose / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D011788:Quality of Life; D012834:Silver / Q000009:adverse effects / Q000627:therapeutic use*; D016037:Single-Blind Method; D014946:Wound Infection / Q000628:therapy*
chemical_list: D000891:Anti-Infective Agents, Local; D001645:Biguanides; C031233:polihexanide; D012834:Silver; D002482:Cellulose