Wound Infection Control Research Articles

Tissue Regeneration in Infected Wounds of Albino Rats Using Ciprofloxacin-Loaded Gelatin Microspheres Incorporated Collagen Scaffold: A Histological Approach with H&E Staining

A wound care system consisting of ciprofloxacin-loaded gelatin microspheres impregnated in a macroporous collagen scaffold was created to effectively control wound infection and regenerate soft tissue at the wound site. Histological and biochemical alterations were observed in infected wounds treated with these scaffolds in Albino Wistar rats. Furthermore, the study examined the immediate and prolonged release of ciprofloxacin from the scaffolds, as well as their function in eliminating bacterial infections and expediting the process of skin healing and regeneration. The developed technique was followed in the streamlined process of creating these collagen scaffolds. Compared to untreated wounds, the group receiving scaffold treatment experienced a faster rate of wound closure. It was noted that the rate of infections was considerably reduced and that full soft tissue regeneration occurred within 12 days. The development of well-deposited collagen bundles in the treated groups was demonstrated by H&E staining, which verified the flawless regeneration of the dermis and epidermis. The antimicrobial agent-loaded gelatin microspheres impregnated into the porous collagen scaffold demonstrated remarkable soft tissue regeneration and efficient infection control at the wound site.

Amikacin sulphate loaded chitosan-diopside nanoparticles composite scaffold for infectious wound healing

A wound dressing material should inhibit infections that may occur at the wound site, and at the same time, it should enhance the healing process. In this study, we developed an amikacin sulphate (AK) incorporated chitosan (Ch) and Diopside nanoparticles composite dressing (Ch-nDE-AK) for controlling wound infection and healing. The diopside nanoparticles (nDE) were prepared using sol-gel synthesis and characterized using XRD, FT-IR, and FESEM. nDE shows a size range of 142 ± 31 nm through FESEM analysis. Later, the developed composite dressing was characterized using SEM, EDS, and FT-IR analysis. Ch-nDE-AK dressing possesses a porous nature that will aid in easy cell infiltration and proliferation. The swelling studies indicated the expansion capability of the scaffold when applied to the injured site. Ch-nDE-AK scaffold showed a 69.6 ± 8.2 % amikacin sulphate release up to 7 days, which indicates the sustained release of the drug from Ch-nDE-AK scaffold. The drug release data was subjected to various kinetics models and was observed to follow the Higuchi model. The scaffold showed antibacterial activity against ATCC strains of S. aureus and E. coli for 7 days by in vitro. Ch-nDE-AK scaffold also showed antibacterial activity against S. aureus and E. coli clinical strains in vitro. The ex vivo antibacterial study confirmed the antibacterial ability of Ch-nDE-AK scaffold against S. aureus and E. coli. Ch-nDE-AK scaffold also exhibits anti-biofilm activity against S. aureus and E. coli. The Ch-nDE-AK scaffold showed cytocompatibility and cell attachment to fibroblast cells. Additionally, the scratch assay using fibroblast cells confirmed the role of the nDE in the scaffold, helping in cell migration. Thus, the developed Ch-nDE-AK dressing can potentially be used to treat infectious wound healing.

Antimicrobial Nonisocyanate Polyurethane Foam Derived from Lignin for Wound Healing.

Medical dressings, as a cover for wounds, can replace damaged skin in the wound healing process to play a temporary barrier role, avoid or control wound infection, and provide a favorable environment for wound healing. Therefore, there is an urgent need for medical antimicrobial dressings for the treatment of chronic wounds. Although traditional polyurethane foam has been widely used in medical dressings, conventional polyurethane foams are primarily prepared using nonbiocompatible isocyanate-based compounds, which are potentially hazardous for both operators and applications in the medical field. Here, we propose nonisocyanate polyurethane foams naturally derived from lignin by enzymatic lignin alkylation, cyclic carbonation modification, and polymerization with diamine and the addition of a blowing agent. Silver nanoparticle solution was added during foaming to confer antimicrobial properties. This lignin-based nonisocyanate polyurethane/silver composite foam (named NIPU foam-silver) using a green synthesis method has good mechanical properties, which can be used to manufacture polyurethane/silver foams, and thermal and antimicrobial properties. Notably, NIPU foam-Ag showed more than 95% bactericidal efficacy against both Escherichia coli and Staphylococcus aureus within 4 h. Evaluation of in vitro wounds in mice showed that this antimicrobial composite foam rapidly promotes wound healing and repairs damaged tissue. This suggests that this biobased biodegradable antimicrobial foam has significant scope for clinical applications in wound management.

Preparation and characterization of a ciprofloxacin-loaded nanoparticles incorporated polymeric film dressing.

In an effort to prepare a modern polysaccharide-based dressing for sustained/prolonged delivery of the antibacterial agent to prevent and control skin wound infection, ciprofloxacin (CP)-loaded sodium alginate (SA)-chitosan (CS) nanoparticles (NPs) were incorporated into novel arabinoxylan (AX)-pectin (PC) blended polymeric films by solvent casting. The CP-NPs were prepared by a two-step ionic interaction method with < 300 nm size, about 25 mV zeta potential, 74% CP-loading efficiency, and approximately round shape. The CP-NPs were incorporated in optimized AX-PC polymeric film prepared by using 2% AX and 2% PC with a plasticizer (2% glycerol) and then these films were characterized for suitability as a film dressing. The transparency, improved mechanical strength, thermal stability, water transmission, and exudate uptake characteristics indicated that CP-NPs incorporated AX-PC polymeric films were suitable for dressing applications. The CP-NPs incorporated AX-PC films exhibited sustained CP release (90% release in 36 h) and better antibacterial susceptibility as compared to free CP-containing AX-PC films. Thus, CP-NPs incorporated AX-PC films are promising dressing materials to prevent and control wound infection with prolonged antibiotic release.

Loop-Mediated Isothermal Amplification of DNA (LAMP) as an Alternative Method for Determining Bacteria in Wound Infections.

The increasing number of patients with chronic wounds requires the development of quick and accurate diagnostics methods. One of the key and challenging aspects of treating ulcers is to control wound infection. Early detection of infection is essential for the application of suitable treatment methods, such as systemic antibiotics or other antimicrobial agents. Clinically, the most frequently used method for detecting microorganisms in wounds is through a swab and culture on appropriate media. This test has major limitations, such as the long bacterial growth time and the selectivity of bacterial growth. This article presents an overview of molecular methods for detecting bacteria in wounds, including real-time polymerase chain reaction (rtPCR), quantitative polymerase chain reaction (qPCR), genotyping, next-generation sequencing (NGS), and loop-mediated isothermal amplification (LAMP). We focus on the LAMP method, which has not yet been widely used to detect bacteria in wounds, but it is an interesting alternative to conventional detection methods. LAMP does not require additional complicated equipment and provides the fastest detection time for microorganisms (approx. 30 min reaction). It also allows the use of many pairs of primers in one reaction and determination of up to 15 organisms in one sample. Isothermal amplification of DNA is currently the easiest and most economical method for microbial detection in wound infection. Direct visualization of the reaction with dyes, along with omitting DNA isolation, has increased the potential use of this method.

Artificial dermis combined with split-thickness skin autograft in the treatment of hand thermal compression wounds: a single center case-control study.

To explore the clinical effect of artificial dermis combined with split-thickness skin autograft in treating hand thermal compression wounds. Forty-two patients in our hospital from January 2016 to October 2022 with thermal compression wounds were divided into two groups. The survival rate of autologous skin grafts seven days after skin grafting, the number of operations, total hospital stay, total hospitalization cost, and bacterial culture results of secretions were recorded. The visual analog scale was used to evaluate the wound pain. The condition of skin graft rupture was recorded and the scar status of the donor site was evaluated by the Vancouver Scar Scale. It showed combination of artificial dermis, split-thickness skin autograft, and vacuum sealing drainage improves the treatment of hand thermal compression wounds by enhancing the survival rate of skin grafting (95.24% > 66.67%), reducing the number of operations (P < 0.001), relieving wound pain (P < 0.001), effectively controlling wound infection (4.76% < 9.52%), and reducing the skin graft rupture rate after surgery (4.8% < 28.6%). There was no evident scar hyperplasia in the donor (P = 0.003) and skin graft areas (P < 0.001), which had a good recovery of hand function (P = 0.037); however, this treatment strategy may prolong the hospital stay (P = 0.030) and increase the total hospitalization cost (P = 0.030). The composite transplantation of artificial dermis and split-thickness skin combined with the VSD significantly improves treatment and aesthetic outcomes in patients with thermal compression wounds to the hand, which is worth promoting and applying in clinical practice.

Use of urine collection as an alternative of custom-made Plastic bag for limited access dressing (LAD)

To evaluate the use of urine collection bag as an alternate of custom-made Plastic bag for Limited Access Dressing (LAD). Moist wound dressings maintains the moist and warm environment suitable for growth of granulation tissues, control wound infection, increased epithelization and reduces pain. One of the recent advances in wound care management is limited access dressing (LAD). It combines the principle of moist wound healing and a negative pressure wound therapy and accures the benefit of both principles.

CLINICAL TREATMENT METHOD FOR PRESSURE INJURY IN OLDER ADULT PATIENTS WITH BONE INJURY

Objective: This study aimed to investigate the effect of Suile ointment wound dressing on wound healing in patients with pressure injury (PI). Methods: Patients with stage II and III PI who met the inclusion criteria were randomly divided into two groups of 20 patients each, according to the National Pressure Ulcer Advisory Panel’s staging table. After debridement, the patients’ wounds in the control group were covered with petrolatum gauze and sterile dressing in the outer layer. Suile ointment wound dressing was applied externally to those in the experimental group, and the outer layer was covered with a sterile dressing. The experimental group included 20 patients with 27 wounds, and the control group included 20 patients with 30 wounds. The white blood cell count, erythrocyte sedimentation rate, and hypersensitive C-reactive protein levels were measured to control wound infection. Results: The overall response rates in the experimental group and the control group were 96.3% and 47%, respectively, and the results were statistically significant. Conclusion: Suile ointment wound dressing (wound care ointment) effectively removes dead tissue, promotes tissue regeneration and local vascular expansion, effectively controls wound infection, and relieves pain in patients with stage II and III PI.

Prevalence of Bacterial Species in Traumatic, Burns and Post-Surgical Wounds: Focus on Emerging Drug Resistance

Introduction: Resistance of bacteria to antibiotics poses a serious challenge in managing and treating wound-related complications. Determining the antibiotic resistance patterns is crucial for guiding appropriate antibiotic therapy to avoid their overuse and emergence of deadly superbugs.&#x0D; Aim: The study was aimed to isolate and detect bacterial species responsible for causing infection in different types of traumatic, burns and post-surgical wounds and antibiotic resistance profile of isolated microorganisms.&#x0D; Methodology: The bacterial load and isolation of microbes was determined by plating of samples onto duplicate blood and MacConkey agar plates. The morphologically distinct bacterial isolates were identified by biochemical tests and susceptibility of bacteria against selected antibiotics was determined by Kirby-Bauer disc diffusion method.&#x0D; Results: The major bacterial strains isolated were Staphylococcus aureus, E. coli, Klebsiella sp. and Pseudomonas aeruginosa. The most prominent bacterial strain found was Staphylococcus aureus, present in more than 54% of collected samples, followed by E. coli, Klebsiella sp., and Pseudomonas aeruginosa, present in 17%, 11%, and 10% of collected samples, respectively. The study further explored that Pseudomonas spp. and Acinetobacter spp. showed resistance against various non-identical antibiotics such as Amikacin (aminoglycosides), Azithromycin (macrolides), Levofloxacin &amp; ciprofloxacin (fluoroquinolones) and Cefazolin (cephalosporins). However, Doxycycline (tetracycline) was the only antibiotic that inhibited the growth of all the bacterial species isolated from the infected wounds. levofloxacin was also one of the effective antibiotics in restricting the growth of Staphylococcus aureus, E. coli and Klebsiella spp.&#x0D; Consequently, the study suggests that Doxycycline followed by levofloxacin may be the most suitable antibiotics for controlling wound infection in this specific geographic region.

Current scenario of traditional medicines in management of diabetic foot ulcers: A review.

Diabetic foot infections and diabetic foot ulcers (DFU) cause significant suffering and are often recurring. DFU have three important pathogenic factors, namely, microangiopathy causing local tissue anoxia, neuropathy making the foot prone to injuries from trivial trauma, and local tissue hyperglycaemia favouring infection and delaying the wound healing. DFU have been the leading cause for non-traumatic amputations of part or whole of the limb. Western medicines focus mainly on euglycaemia, antimicrobials, debridement and wound cover with grafts, and off-loading techniques. Advances in euglycaemic control, foot care and footwear, systemic antimicrobial therapy, and overall health care access and delivery, have resulted in an overall decrease in amputations. However, the process of wound care after adequate debridement remains a major cost burden globally, especially in developing nations. This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence. Wound modulation with various dressings and techniques are often a costly affair. Some aspects of the topical therapy with modern/Western medicines are frequently not addressed. Cost of and compliance to these therapies are important as both the wounds and their treatment are "chronic." Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations, though without adequate clinical base/relevance. Traditional Chinese medicine involves restoring yin-yang balance, regulating the 'chi', and promoting local blood circulation. Traditional medicines from India have been emphasizing on 'naturally' available products to control wound infection and promote all the aspects of wound healing. There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns. Various natural and plant derived products (e.g., honey, aloe vera, oils, and calendula) and maggots are also used for wound healing purposes. We believe that patients with a chronic wound are so tired physically, emotionally, and financially that they usually accept native traditional medicine which has the same cultural base, belief, and faith. Many of these products have never been tested in accordance to "evidence-based medicine." There are usually case reports and experience-based reports about these products. Recently, there have been some trials (in vitro and in vivo) to verify the claims of usage of traditional medicines in management of DFU. Such studies show that these natural products enhance the healing process by controlling infection, stimulating granulation tissue, antimicrobial action, promoting fibroblastic activity and collagen deposition, etc. In this review, we attempt to study and analyse the available literature on results of topical traditional medicines, which are usually advocated in the management of DFU. An integrated and 'holistic' approach of both modern and traditional medicine may be more acceptable to the patient, cost effective, and easy to administer and monitor. This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.

A multifunctional PAN/PVP nanofiber sponge wound dressing loaded with ZIF-8-derived carbon nanoparticles with adjustable wetness for rapid wound disinfection and exudate management.

Rapid and safe disinfection and exudate management are two major challenges in infected wound care. Therefore, in this work, we developed a novel wound dressing via encapsulating ZIF-8-derived carbon nanoparticles in a hydrophilic nanofiber sponge to address severe wound infection and heavy exudate problems. The dressing can effectively kill bacteria through chemo-photothermal synergistic therapy. Meanwhile, the hydrophilic nanofiber sponge can quickly absorb wound exudate around the wound and accelerate the evaporation rate of liquid through the photothermal effect and its own structure; therefore, it is possible to remove excess liquid and regulate its wetness. In this way, it prevents the problem of wound overhydration often caused by hydrophilic dressings. In our experiment, the dressing showed good antibacterial performance and biocompatibility in vitro and could effectively control wound infection, absorb wound exudate and promote skin wound healing in vivo. Its good therapeutic effect is not only due to effective infection control and wound exudate management, but also because the structure of nanofibers similar to an extracellular matrix provides basic physical support and structural signals conducive to skin tissue regeneration.

A lipophilic chitosan-modified self-nanoemulsifying system influencing cellular membrane metabolism enhances antibacterial and anti-biofilm efficacy for multi-drug resistant Pseudomonas aeruginosa wound infection.

Wound infections, especially infections with multidrug-resistant bacteria, are a serious public health issue worldwide. In addition, the accumulation microbial biofilm of multidrug-resistant Pseudomonas aeruginosa increases the risk and physically obstruct its healing activity at the wound site. Therefore, the development of an eminent agent to control wound infection is urgently needed. Here, we report a novel chitosan (a natural biological macromolecule)-modified self-nanoemulsifying system (CSN) with lipophilic chlorhexidine acetate (CAA, a poorly water-soluble agent) that was designed and prepared using low-energy emulsification methods. We found that CSN displays better antibacterial efficacy, which occurs more quickly than its aqueous solution, in destroying the structure of the bacterial cell membrane and promoting the leakage of nucleic acids, proteins, K+, and Mg2+ from Pseudomonas aeruginosa cells. Importantly, CSN also accelerates skin wound healing after Pseudomonas aeruginosa infection by inhibiting biofilm formation and eradicating mature biofilms. Moreover, the proteomic results suggested that CSN altered membrane permeability and cellular membrane metabolism, allowing more drug molecules to enter the cytosol. Based on these results, this lipophilic self-nanoemulsifying system may be applied in the treatment of skin wounds caused by multidrug-resistant bacteria, especially Pseudomonas aeruginosa.

Distinct Antimicrobial Analysis to Evaluate Multi-Component Wound Dressing Performance

Wound infection hinders adequate healing, being particularly grievous and prevalent in burn wounds and chronic wounds. Wound infection extends inflammation, preventing epithelialization and angiogenesis. Therefore, infection prolongs healing time, steeply increases treatment costs and degrades patients wellbeing. One successful strategy to control wound infection is to apply an active wound dressing, able to eliminate or significantly reduce the microbial population present at the infection site. Silver nanoparticles (AgNPs) are a multipurpose antimicrobial agent with a wide scope of applications which include wound dressings. Nevertheless, several studies denote AgNPs dose-dependent cytotoxicity, and their capability to bypass the blood-brain barrier and induce a neurotoxic effect. Hence, we propose to adopt two different strategies to attempt the simultaneously immobilize and increase the load of AgNPs within the wound dressing fabric. Thus, the envisaged objective is to prevent potential systemic cytotoxicity /through immobilization and to improve its antimicrobial capability due to the higher concentration of AgNPs. Two different approaches were used: i. AgNPs were suspended in an alginate (ALG) solution, ii. AgNPs were embedded in Mordenite (MOR) zeolite, followed by addition of an ALG solution. Both suspensions were incorporated into polyester fabric assisted by its surface activation by dielectric barrier discharge (DBD) plasma treatment. The bactericidal and virucidal effectiveness of each composite was tested against bacteria species known to induce nosocomial infections and a bacteriophage that is a potential surrogate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Two distinct antimicrobial analysis were used to provide insights on the antimicrobial effectiveness of the obtained composites and to indirectly assess the release of AgNPs.

Rapid fabrication of bionic pyrogallol-based self-adhesive hydrogel with mechanically tunable, self-healing, antibacterial, wound healing, and hemostatic properties.

Hydrogels are functional materials that are similar to human skin and have received much attention in recent years for biomedical applications. However, the preparation of nontoxic, highly adhesive, and antimicrobial hydrogels in an efficient way remains a great challenge. Inspired by adhesive mussel foot proteins (mfps) which consist of abundant catecholic amino acids and lysine (Lys) residues, gallic acid-modified ε-poly-L-lysine (EPL/GA) was synthesized, and an active functional monomer (AA-EPL/GA) was then created through a reaction with acrylic acid (AA). The polymerization of AA-EPL/GA occurred rapidly (30-160s) under blue light (λ=405nm) irradiation to produce a biomimetic PAA-EPL/GA hydrogel under mild conditions. The biomimetic pyrogallol-Lys distribution endowed the PAA-EPL/GA hydrogels with superior adhesion in humid environments (with an adhesive strength of 50.02kPa toward wet porcine skin) and tunable mechanical and self-healing properties. Additionally, the PAA-EPL/GA hydrogels exhibited outstanding antibacterial ability due to the inherent characteristics of GA and EPL. In a mouse model, PAA-EPL/GA adhered firmly around the wound tissues. Photographs of the wound and the histological results demonstrated the ability of the hydrogel to promote wound healing, control wound infection, and suppress scar formation. Moreover, the hydrogel had a good hemostatic effect on liver bleeding. Our results highlighted the promising application potential of GA-based hydrogels, which were easily, harmlessly, and efficiently fabricated by blue light irradiation.

Antimicrobial Synthetic and Natural Polymeric Nanofibers as Wound Dressing: A Review

Since ancient times, wound dressings have experienced many significant improvements. Evolution began using natural materials to merely cover wounds and advanced to used innovative techniques that can be customized to perform different impressive functions. Recent wound dressings, which are made of electrospun polymers, contain different active compounds, such as antimicrobial agents, that aid in wound healing and prevent dehydration and infection. The mentioned issues may influence the healing process, leading even to serious health risks for the patients. As a result, scientists are now working on novel wound bandages with improved antimicrobial properties. Electrospun polymeric nanofibers, because of their structural similarities to normal skin's extracellular matrix (ECM), bactericidal activity, and appropriateness to distribute bioactive molecules to the wound location, are regarded as good resources for enhancing skin regeneration and controlling wound infection. Herein, the latest findings on approaches for producing antimicrobial polymeric nanofibers using electrospinning and related processes are discussed. Recent advances in antibacterial biopolymeric nanofibers incorporating antimicrobial nanoparticles (silver, zinc oxide, copper oxide, etc.) are discussed. This review paper may raise significant issues, encourage additional research, and offer important insight into the potential area of antibacterial polymeric fibers.

Study on the influence and countermeasures of high-quality nursing in controlling wound infection in emergency treatment of hand trauma.

article: Study on the influence and countermeasures of high-quality nursing in controlling wound infection in emergency treatment of hand trauma - Minerva Surgery 2022 December;77(6):612-4 - Minerva Medica - Journals

Fabrication of collagen with polyhexamethylene biguanide: A potential scaffold for infected wounds.

Bacterial infection remains a great challenge in wound healing, especially in chronic wounds. Multidrug-resistant organisms are increasing in acute and chronic wound infections, which compromise the chance of therapeutics. Resistance to conventional antibiotics has created an urge to study new approach/system that can effectively control wound infection and enhance healing. Wound cover/dressing must exhibit biocompatibility and effectiveness in reducing bioburden at the wound site. Collagen, a natural biopolymer, possesses advantages over synthetic and other natural materials due to its unique biological properties. It can act as an excellent wound dressing and controlled drug delivery system. Currently, antiseptic agents such as silver, iodine, and polyhexamethylene biguanide (PHMB)-incorporated scaffolds have become widely accepted in chronic wound healing. In this study, PHMB-incorporated collagen scaffold has been prepared and characterized using Fourier transform infrared spectroscopy (FTIR), circular dichroism (CD), and differential scanning calorimetry (DSC), which showed retention of collagen nativity and integration of PHMB. The scanning electron microscopy (SEM) analysis revealed the porous structures of scaffolds. The cytotoxicity analysis showed PHMB is nontoxic at the concentration of 0.01% (wt/wt). The agar diffusion test and bacterial adhesion study demonstrated the effectiveness of PHMB-incorporated collagen scaffold against both gram positive and negative strains. This study concludes that PHMB-incorporated collagen scaffold could have the potential for infected wound healing.

Carbon Quantum Dots Derived from Different Carbon Sources for Antibacterial Applications.

Nanoparticles possess unique features due to their small size and can be composed of different surface chemistries. Carbon quantum dots possess several unique physico-chemical and antibacterial activities. This review provides an overview of different methods to prepare carbon quantum dots from different carbon sources in order to provide guidelines for choosing methods and carbon sources that yield carbon quantum dots with optimal antibacterial efficacy. Antibacterial activities of carbon quantum dots predominantly involve cell wall damage and disruption of the matrix of infectious biofilms through reactive oxygen species (ROS) generation to cause dispersal of infecting pathogens that enhance their susceptibility to antibiotics. Quaternized carbon quantum dots from organic carbon sources have been found to be equally efficacious for controlling wound infection and pneumonia in rodents as antibiotics. Carbon quantum dots derived through heating of natural carbon sources can inherit properties that resemble those of the carbon sources they are derived from. This makes antibiotics, medicinal herbs and plants or probiotic bacteria ideal sources for the synthesis of antibacterial carbon quantum dots. Importantly, carbon quantum dots have been suggested to yield a lower chance of inducing bacterial resistance than antibiotics, making carbon quantum dots attractive for large scale clinical use.

創傷の感染制御にiSAP（intra-soft tissue antibiotics perfusion）を用いた経験

創傷の感染制御にiSAP（intra-soft tissue antibiotics perfusion）を用いた経験

Antimicrobial stewardship of antiseptics that are pertinent to wounds: the need for a united approach.

Long before the nature of infection was recognized, or the significance of biofilms in delayed healing was understood, antimicrobial agents were being used in wound care. In the last 70 years, antibiotics have provided an effective means to control wound infection, but the continued emergence of antibiotic-resistant strains and the documented antibiotic tolerance of biofilms has reduced their effectiveness. A range of wound dressings containing an antimicrobial (antibiotic or non-antibiotic compound) has been developed. Whereas standardized methods for determining the efficacy of non-antibiotic antimicrobials in bacterial suspension tests were developed in the early twentieth century, standardized ways of evaluating the efficacy of antimicrobial dressings against microbial suspensions and biofilms are not available. Resistance to non-antibiotic antimicrobials and cross-resistance with antibiotics has been reported, but consensus on breakpoints is absent and surveillance is impossible. Antimicrobial stewardship is therefore in jeopardy. This review highlights these difficulties and in particular the efficacy of current non-antibiotic antimicrobials used in dressings, their efficacy, and the challenges of translating in vitro efficacy data to the efficacy of dressings in patients. This review calls for a unified approach to developing standardized methods of evaluating antimicrobial dressings that will provide an improved basis for practitioners to make informed choices in wound care.