Wound care
Rethinking wound infection management
Interest is growing in dressing technologies that manage bacteria without releasing antimicrobial substances. In this article, Ashley Clydesdale questions: is it time to re-evaluate silver’s role in today’s wound care?
Antimicrobial resistance (AMR) is widely recognised as one of the most critical global health challenges of the 21st century, with the World Health Organization warning that it threatens the very core of modern medicine.1 Recent analysis identified that globally 4.95 million deaths in 2019 were associated with antibiotic resistant bacteria,2
the equivalent
of the population of New Zealand dying in one year. If the situation is left unaddressed, it is estimated that AMR related infections could cause 8.22 million deaths each year, by 2050, globally.3 Antimicrobials, like antibiotics, antiseptics and antivirals, are medicines that help prevent and treat infections in people, animals, and plants. AMR happens when microbes such as bacteria, viruses, fungi, and parasites change so that these medicines no longer work. This makes infections harder to treat and can lead to more illness and even death. While resistance can occur naturally over time, it is sped up by the misuse and overuse of these medicines in healthcare and farming, in particular with antibiotics.
AMR is a major challenge in wound
care, particularly in immunocompromised patients and those frequently exposed to hospitals.4
Studies show that up to 20% of wound microbes may be resistant.5 Against
that backdrop, infection prevention and antimicrobial stewardship (AMS), which focuses on ensuring the responsible and effective use of antimicrobial medicines, are increasingly fundamental to the future of safe wound care and wider health outcomes. As antibiotics have become less reliable in the face of multidrug-resistant organisms, clinicians have increasingly turned to topical antimicrobial agents to control bioburden (the level of microbial contamination in a wound) and manage biofilm (the structured community of microorganisms that adheres to surfaces and is difficult to remove).6
This shift has driven
a marked rise in the use of antimicrobial dressings over the past two decades, particularly those containing silver. Silver’s broad-spectrum antimicrobial
properties made it a logical choice as antibiotic resistance grew. It offered a familiar, seemingly
dependable alternative at a time when other options were losing efficacy.7
As a result, silver
has become deeply embedded in routine practice and equated to 40.8% of antimicrobial dressings used through drug tariff within the United Kingdom, from September 2024 to October 2025.8
(See Table 1) The heavy reliance on silver has created a
critical unintended consequence. There is a rapidly growing body of evidence to show that sustained use is contributing to the emergence of silver-resistant bacteria, mirroring the very challenge that silver was intended to help solve7
Technologies that do not release biocides into the wound bed — such as dialkylcarbamoyl chloride (DACC), which physically binds, inhibits, and removes bacteria — offer a credible pathway forward without the associated risk of AMR development.
As the NHS and the wider healthcare
sector intensify their AMS efforts, these purely mechanical dressings present a valuable opportunity to reduce the risk of AMR development in wound care, safeguard the efficacy of traditional active antimicrobial agents, and maintain effective control of bacterial burden.
50% 38% 25% 13% 0%
Silver Iodine Honey DACC Phmb Other Copper Carbon
Table 1: Percentage by volume of antimicrobial agents used over 12 months, through reimbursement in wound care.8
Re-evaluating silver’s role in today’s wound care Silver has been used to control infection for centuries. For example, ancient mariners dropped silver coins into drinking barrels to prevent fouling.9
.
Silver in wound care comes
in various formulations, including ionic silver, nanocrystalline silver (AgNPs), silver salts, silver sulfadiazine, and silver-impregnated dressings. These forms differ mainly in how they release silver ions, which provide antimicrobial action, and are chosen based on wound type and infection risk. Silver exerts its antimicrobial effect primarily through the release of silver ions (Ag), which interact with multiple cellular targets. These ions bind to bacterial cell membranes, increasing permeability and causing structural
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