Objectives
The issue of antimicrobial resistance (AMR) is an ever increasing global concern. Wound care is no exception; in burn centres the selective pressure from high antibiotic use, ineffective antibiotic dose at site of injury due to altered drug pharmacokinetics and pharmacodynamics and longer hospitalization and treatment regimens all may influence the risk of resistance development.
Antibiotic resistance and stewardship (AMS) have been the priority for most strategic interventions so far, however, in wound care other alternative or supplementary strategies using antiseptics should be considered. Local antiseptics such as silver can provide effective cidal activity across a broad range of wound pathogens including antibiotic resistant organisms, assuming they are used in the correct dose for an appropriate time period. The aim of this study was to understand the role of nanocrystalline silver barrier dressings as part of a strategy to tackle antimicrobial resistance in burns.


Methods
A search of published evidence that supports the position of effective silver barrier dressings containing nanocrystalline silver within an AMR and AMS strategy for wound care literature was performed. The evidence supporting the role of this silver barrier dressing in burn wounds was subsequently summarised in the context of infection control, appropriate antimicrobial use and reduced antibiotic use.


Results
An increasing body of evidence is available to support nanocrystalline silver use to minimise transmission of antibiotic resistant organisms as part of infection control procedures and in addition, through appropriate early use and stewardship on local wound infections, to minimise the need for systemic antibiotic therapy in surgical wounds and burns.


Conclusion
Engagement, alignment and collaboration between wound care professionals and wider related teams and governments on antimicrobial stewardship, and the potential role of antiseptics within this will help to progress further evidence for such interventions in the fight against antimicrobial resistant infections in wound care.

4 - Antimicrobial resistance in burn wound care - evidence to support a role for nanocrystalline silver to tackle this increasing global problem.