Cath Lab Digest

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Abstract

  Between 5% and 10% of cancer patients develop malignant wounds. In vitro and some clinical studies suggest that silver- or honey-coated dressings may have an antibacterial effect in nonmalignant wounds, but their possible antibacterial effect in malignant wounds remains unknown. A prospective, randomized, single-blind controlled clinical study was conducted to evaluate the bacteriology of malignant wounds and compare the effect of a honey-coated (Group A) to a silver-coated (Group B) dressing on the qualitative bacteriology of malignant wounds. All wound interventions were performed by the same healthcare professional. Swab cultures were obtained at baseline and following a 4-week intervention and were evaluated without information about the patient treatment group. Of the 75 patients with advanced cancer and malignant wounds identified, 67 (34 in group A, 33 in group B; median age 64 years, range 47–92) consented to participate and completed the 4-week study. The majority were women (88%) with breast cancer (79%). No statistically significant differences were found between the type and number of different wound pathogens in the wounds during the course of the study or between Group A and Group B. Neither anti-neoplastic nor antibiotic treatment influenced the presence of wound pathogens. Staphylococci were found in 42%, enteric bacteria in 34%, anaerobic bacteria in 16%, Pseudomonas in 10%, and hemolytic Streptococci in 6% of wounds at baseline; in total, 25 different bacterial species were identified. Sixty-one percent (61%) of wounds decreased in size following treatment, but no significant differences were observed between the type and variety of wound pathogens and whether wound size decreased. Although quantitative bacteriological changes may have occurred, the possible antibacterial effect of the honey or silver dressing could not be confirmed in these malignant wounds. Routine wound swabbing of malignant wounds is of little value and should be restricted to cases where signs of infection requiring antibiotic intervention are observed or where resistant organisms require special infection control measures.

Key Words: randomized controlled study, malignant wound, cultures, honey-coated dressing, silver-coated dressing

Index: Ostomy Wound Management 2011;57(7):28–36

Potential Conflicts of Interest: none disclosed

  An estimated 5% to 10% of all cancer patients develop malignant wounds.¹ The wounds that often occur in advanced stage cancer result from tumors that infiltrate the skin and underlying tissues.² The base of the malignant wound is characterized by the presence of necrotic and tumor tissue, slough, and fibrin, stimulating the growth of anaerobic bacteria that can produce odor and infection in the wound.^3,4 Complete healing, as a rule, is not a realistic outcome in this type of patient due to the presence of cancer tissue in the wound base.⁵

  One could speculate that if dressings with antibacterial properties could reduce the growth of bacteria and resultant odor in the malignant wound, optimal healing could be facilitated. Both honey^6,7 and silver dressings⁸ have shown antibacterial effects in other chronic wounds such as leg ulcers, but there is no evidence from randomized clinical trials (RCTs)⁹ about their effect on malignant wounds, and no controlled studies exist that compare the effect of silver-coated versus honey-coated dressings in chronic wounds.

  The aim of this study is to compare the effect of honey-coated and silver-coated dressings on the qualitative bacteriology in malignant wounds.