A pre-clinical evaluation of silver, iodine and Manuka honey based dressings in a model of traumatic extremity wounds contaminated with Staphylococcus aureus

Injury. 2014 Aug;45(8):1171-8. doi: 10.1016/j.injury.2014.05.007. Epub 2014 May 17.


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.

Keywords: Dressings; Extremity; Honey; Infection; Injury; Iodine; Military; S. aureus; Silver; Wounds.

Publication types

  • Evaluation Study

MeSH terms

  • Afghan Campaign 2001-
  • Animals
  • Anti-Bacterial Agents / pharmacology*
  • Arm Injuries / etiology
  • Arm Injuries / therapy
  • Bacteremia / microbiology
  • Bacteremia / prevention & control*
  • Bacterial Load / drug effects
  • Bandages*
  • Disease Models, Animal
  • Female
  • Honey*
  • Humans
  • Iodine Compounds / pharmacology*
  • Leg Injuries / etiology
  • Leg Injuries / therapy
  • Male
  • Military Medicine
  • Rabbits
  • Random Allocation
  • Silver Compounds / pharmacology*
  • Soft Tissue Injuries / drug therapy
  • Soft Tissue Injuries / microbiology
  • Soft Tissue Injuries / therapy*
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / prevention & control
  • Staphylococcal Infections / therapy*
  • Staphylococcus aureus / drug effects
  • United Kingdom
  • Wound Healing / drug effects*
  • Wound Infection / drug therapy
  • Wound Infection / microbiology
  • Wound Infection / therapy*


  • Anti-Bacterial Agents
  • Iodine Compounds
  • Silver Compounds