South Western Sydney Local Health District, Liverpool Hospital, Sydney, New South Wales, Australia.
South West Sydney Limb Preservation and Wound Research Academic Unit, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.
Int Wound J. 2024 Oct;21(10):e70053. doi: 10.1111/iwj.70053.
Reports of overuse and antimicrobial resistance have fuelled some clinicians to adopt alternative wound dressings termed to be non-medicated or non-antimicrobials, which still claim antimicrobial or antibacterial activity. In this PROSPERO-registered systematic review, we evaluated the in vivo clinical evidence for the effectiveness of DACC-coated dressings in chronic, hard to heal wound-related outcomes. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Framework was adopted as the template in constructing this systematic review. The PICO format (Population [or patients], Intervention, Comparison [control], Outcome/s) was used to identify key clinical questions in determining patient outcomes under two domains (infection control and wound healing). A systematic search was performed in PubMed, OVID, Cochrane Library, clinical trial registries and data sources from independent committees. Abstracts of all studies were screened independently by two reviewers, with six further reviewers independently assessing records proceeding to full review. The authors rated the quality of evidence for each of the outcomes critical to decision making. After excluding duplicates, 748 records were screened from the databases, and 13 records were sought for full review. After full review, we excluded a further three records, leaving ten records for data extraction. Three records were narrative reviews, three systematic reviews, two prospective non-comparative before/after studies, one prospective head-to-head comparator cohort study and one retrospective head-to-head comparator cohort study. No RCTs or case versus control studies were identified. The overall quality of clinical evidence for the use of DACC-coated dressing to improve wound infection and wound healing outcomes was assessed as very low. There is an urgent unmet need to perform appropriately designed RCTs or case-control studies. The extracted data provide no clarity and have limited to no evidence to support that using a DACC-coated dressing improves wound infection or wound healing outcomes. Further, there is no evidence to suggest this therapy is either superior to standard of wound care or equivocal to topical antimicrobial agents in the management of infected hard to heal wounds.
报告称，过度使用和抗微生物药物耐药性促使一些临床医生采用被称为非药物或非抗微生物的替代伤口敷料，这些敷料仍声称具有抗微生物或抗菌活性。在这项经过 PROSPERO 注册的系统评价中，我们评估了 DACC 涂层敷料在慢性、难以愈合的伤口相关结局方面的体内临床疗效证据。采用推荐分级、评估、制定与评价（GRADE）框架作为构建系统评价的模板。采用 PICO 格式（人群[或患者]、干预、比较[对照]、结局）确定两个领域（感染控制和伤口愈合）中确定患者结局的关键临床问题。在 PubMed、OVID、Cochrane 图书馆、临床试验注册处和独立委员会的数据来源中进行系统检索。两名评审员独立筛选所有研究的摘要，另外六名评审员独立评估进入全面审查的记录。作者对每个对决策至关重要的结局的证据质量进行了评分。排除重复项后，从数据库中筛选出 748 条记录，并进一步检索了 13 条记录进行全面审查。全面审查后，我们又排除了 3 条记录，留下 10 条记录进行数据提取。有 3 条记录是叙述性综述，3 条系统评价，2 项前瞻性非对照前后研究，1 项前瞻性头对头比较队列研究和 1 项回顾性头对头比较队列研究。没有发现 RCT 或病例对照研究。使用 DACC 涂层敷料改善伤口感染和伤口愈合结局的临床证据总体质量被评估为非常低。迫切需要开展设计恰当的 RCT 或病例对照研究。提取的数据没有提供明确的信息，也没有充分的证据支持使用 DACC 涂层敷料可以改善伤口感染或伤口愈合结局。此外，没有证据表明这种治疗在治疗感染性难以愈合的伤口方面优于标准的伤口护理，或者与局部抗菌药物相当。
