title: Comparative study of two antimicrobial dressings in infected leg ulcers: a pilot study.
abstract: OBJECTIVE
  The aim of the study was to compare the efficacy of a microorganism-binding (MB) dressing with a silver-containing hydrofiber (SCH) dressing in controlling the bacterial loads of heavily colonised or locally infected chronic venous leg ulcers, before surgical management with homologous skin grafts.
  
  
  METHODS
  A randomised comparative single centre study recruited patients presenting with hard-to-heal critically colonised or locally infected leg ulcers, who could be treated with skin grafting. Inclusion criteria included; ulcers of vascular aetiology, over 18 years old, a wound duration ≥6 months and ankle brachial index (ABPI) >0.6. Patients were randomly assigned to treatment with SCH dressings (Aquacel Ag) or MB dressing (Cutimed Sorbact). Dressings were changed daily over a four-day observation period, after which they were taken for a skin grafting procedure. Swab samples from ulcer beds were taken in order to quantify the bacterial load at inclusion (D0) and at the end of the observation period day 4 (D4). No antibiotics were administered before or during the evaluation period.
  
  
  RESULTS
  Both groups (n=20 SCH, n=20 MB) were similar in gender, age, pathophysiology (both had 15 patients with venous leg ulcers and 5 with arterial leg ulcers), ulcer surface, ulcer duration, treatment-related pain and initial bacterial load. Analysing bacterial load variation showed a significant reduction of bacterial burden at D4 in both groups. In the SCH group, we found an average bacterial load reduction of 41.6%, with an average reduction of 73.1% in the MB group (p< 0.00001). No serious adverse events were reported.
  
  
  CONCLUSIONS
  Our evaluation confirmed that MB and SCH dressings are effective in reducing the bacterial burden in critically colonised or locally infected chronic leg ulcers, without inducing adverse events, with MB dressings significantly more effective.
  
  
  BACKGROUND
  There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
authors.affiliation: Head Angiology Department, All at Angiology Department, Barbantini Hospital, Lucca, Italy Via del Calcio 2, 55100 Lucca, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mosti
authors.forename: A
authors.initials: A
authors.lastname: Magliaro
authors.forename: V
authors.initials: V
authors.lastname: Mattaliano
authors.forename: P
authors.initials: P
authors.lastname: Picerni
authors.forename: N
authors.initials: N
authors.lastname: Angelotti
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D058491:Bacterial Load; D047070:Bandages, Hydrocolloid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018030:Silver Compounds / Q000008:administration & dosage*; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000890:Anti-Infective Agents; D018030:Silver Compounds
keywords: antimicrobial dressing; bacterial load; efficacy; infection; leg ulcers; skin allograft