The risk to develop bacterial resistance against silver in wound care - updated evaluation of published data

At this year's EWMA congress, an E-poster with the title "The risk to develop bacterial resistance against silver in wound care - updated evaluation of published data" has been presented (03/05/2017, E-poster Screen 2). Link: http://ewma.conference2web.com/#!contentsessions/22432Johannes Georg Böttrich (1), Horst Braunwarth (2), Joachim Dissemond (3), Hilt Joerg (4), Karl-Christian Münter (5), Patricia Wilken (6)(1) B.Braun Melsungen AG, Medical Scientific Affairs Opm, Melsungen, Germany(2) Coloplast GmbH, Hamburg, Germany(3) University Hospital of Essen, Abteilung für Dermatologie, Essen, Germany(4) Smith & Nephew GmbH, Hamburg, Germany(5) Gemeinschaftspraxis, General Medicine, Phlebology, Hamburg, Germany(6) Urgo GmbH, Sulzbach, GermanyAim:The increasing emergence of resistances presents a big challenge for medical treatment procedures like local therapy of wounds with local signs of infection. The aim of this survey was to update our analysis on the risk to develop bacterial resistance against ionic silver [Braunwarth 2014].Method:Based on published data a structured Pub Med-Search was conducted (2013/01/01 to 2016/10/31) with the following search terms: silver / resistance, silver / bacterial resistance, silver / bacterial tolerance, silver / bacterial susceptibility, silver / tolerance and silver / susceptibility. In addition an Embase search with the search terms Silver / antimicrobial / resistance was realized. All papers relevant to these terms were includedResults / Discussion:Out of 991 publications (PubMed 309; Embase 682) 17 were finally included. Main key results:- Only a few silver resistant bacteria were isolated [Sterling 2014].- Antibiotics appear to bear more resistance determinants than antiseptics [Murray 2015].- The universal susceptibility of staphylococci to Ag+ and failure to select for resistance to Ag+ underline advantages of silver- over antibiotics-therapy [Randall 2013].- Mobile genetic elements [Mijnendoncks 2013] and reduction of Ag+-ions [Muller & Merrett 2014; Finley 2015] are discussed as resistance mechanisms.- Silver can probably restore/improve the action of antibiotics against GN-bacteria [Morones-Ramirez 2013].- Although silver resistance is of concern [Sterling 2014] it is exceptionally rare and generally of no clinical relevance [Marx & Barillo 2014].Conclusion:This search indicates that silver resistance is apparently of no clinical relevance in wound care.