Utilization of Advanced Antimicrobial Extracellular Matrix Technology Within the Framework of Antimicrobial Stewardship

Abstract Body: Introduction: The availability of advanced tissue regeneration products in the field of wound care has enabled the implementation of more aggressive wound treatment strategies to address underlying wound pathology, rather than simply managing wound symptoms such as exudate and malodor.1  While traditional collagen dressings provide excellent moisture balance, modern advanced extracellular matrix (ECM) technologies provide a structural scaffold and are enriched with a gamut of native tissue biological factors to rebuild missing or damaged tissues.2 An antimicrobial ECM technology (ECM/Ag†) incorporating ionic silver, contains over 151 ECM proteins,3 and has  shown effectiveness against both gram negative and gram positive bacteria, including some of the multidrug-resistant strains.4 Additionally, ECM/Ag has been shown to prevent the reformation of biofilm in in vitro models. 4 Method: The following case series (n=6 wounds) included a range of different wound etiologies and sought to evaluate ECM/Ag† for the treatment of chronic wounds. All wounds were managed with current best practice including wound debridement. In several cases flora in the wound bed was imaged with a fluorescence imaging system prior to debridement and initiation of ECM/Ag† management. Results:  All wounds responded well to the antimicrobial ECM with robust granulation tissue formation and advancement of epithelial tissues and ultimate closure. Conclusion:  Closure of chronic wounds is challenging and external factors, such as infection or bacterial colonization of a wound add to these challenges and intensify the barriers to adequate wound closure. Wound care practitioners, as they adhere to antimicrobial stewardship guidelines need to consider the inclusion of antimicrobial ECM technology as an option particularly in the management of chronic wounds.