title: A pre-clinical evaluation of silver, iodine and Manuka honey based dressings in a model of traumatic extremity wounds contaminated with Staphylococcus aureus.
abstract: Prevention of extremity war wound infection remains a clinical challenge. Staphylococcus aureus is the most common pathogen in delayed infection. We hypothesised that choice of wound dressings may affect bacterial burden over 7 days reflecting the current practice of delayed primary closure of wounds within this timeframe. A randomised controlled trial of 3 commercially available dressings (Inadine(®) (Johnson & Johnson, NJ, USA), Acticoat(®) (Smith & Nephew, Hull, UK), Activon Tulle (Advancis Medical, Nottingham, UK)) was conducted in a rabbit model of contaminated forelimb muscle injury. A positive control group treated with antibiotics was included. Groups were compared to a saline soaked gauze control. The primary outcome was a statistically significant reduction (p < 0.05) in tissue S. aureus at 7 days post-injury. Secondary outcome measurements included bacteraemias, observational data, whole blood determination, ELISA for plasma biomarkers, PCR array analysis of wound healing gene expression and muscle/lymph node histopathology. Antibiotic, Inadine and Acticoat groups had statistically significant lower bacterial counts (mean 7.13 [95% CI 0.00-96.31]×10(2); 1.66 [0.94-2.58]×10(5); 8.86 [0.00-53.35]×10(4)cfu/g, respectively) and Activon Tulle group had significantly higher counts (2.82 [0.98-5.61]×10(6)cfu/g) than saline soaked gauze control (7.58 [1.65-17.83]×10(5)cfu/g). There were no bacteraemias or significant differences in observational data or whole blood determination. There were no significant differences in muscle/loss or pathology and lymph node cross-sectional area or morphology. There were some significant differences between treatment groups in the plasma cytokines IL-4, TNFα and MCP-1 in comparison to the control. PCR array data demonstrated more general changes in gene expression in the muscle tissue from the Activon Tulle group than the Inadine or Acticoat dressings with a limited number of genes showing significantly altered expression compared to control. This study has demonstrated that both Acticoat(®) and Inadine(®) dressings can reduce the bacteria burden in a heavily contaminated soft tissue wound and so they may offer utility in the clinical setting particularly where surgical treatment is delayed.
authors.affiliation: Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, United Kingdom. Electronic address: hugoguthrie@doctors.org.uk.
authors.forename: Hugo C
authors.initials: HC
authors.lastname: Guthrie
authors.affiliation: Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Martin
authors.affiliation: Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Taylor
authors.affiliation: Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Spear
authors.affiliation: Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Whiting
authors.affiliation: Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom.
authors.forename: Sara
authors.initials: S
authors.lastname: Macildowie
authors.affiliation: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, United Kingdom.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Clasper
authors.affiliation: Biomedical Sciences Department, Building 245, Defence Science and Technology Laboratory, Porton Down, Wiltshire SP4 0JQ, United Kingdom. Electronic address: sawatts1@dstl.gov.uk.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Watts
mesh_terms: D055826:Afghan Campaign 2001-; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001134:Arm Injuries / Q000209:etiology / Q000628:therapy; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control*; D058491:Bacterial Load / Q000187:drug effects; D001458:Bandages; D004195:Disease Models, Animal; D005260:Female; D006722:Honey; D006801:Humans; D017613:Iodine Compounds / Q000494:pharmacology*; D007869:Leg Injuries / Q000209:etiology / Q000628:therapy; D008297:Male; D008887:Military Medicine; D011817:Rabbits; D011897:Random Allocation; D018030:Silver Compounds / Q000494:pharmacology*; D017695:Soft Tissue Injuries / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D013211:Staphylococcus aureus / Q000187:drug effects; D006113:United Kingdom; D014945:Wound Healing / Q000187:drug effects*; D014946:Wound Infection / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D017613:Iodine Compounds; D018030:Silver Compounds
keywords: Dressings; Extremity; Honey; Infection; Injury; Iodine; Military; S. aureus; Silver; Wounds