DACC-coated versus silver hydrofibre dressings in paediatric polymicrobial wound infections: optimising infection control and antimicrobial stewardship.

OBJECTIVE: Paediatric and neonate patients are more susceptible to wound infection and skin damage. Dressing interventions for paediatric wounds need to balance effective infection management with patient satisfaction and tolerance. The aim was to evaluate a dialkylcarbamoyl chloride (DACC)-based wound care strategy in paediatric patients with complex wounds using both a cohort comparison with silver hydrofibre (SHF) dressings and a wider non-comparative analysis describing the overall institutional experience with DACC-coated dressings. METHOD: This retrospective comparative study design compared clinical outcomes in paediatric wounds managed with DACC-coated dressings to SHF dressings. Wound and microbiological-related outcomes were analysed. In addition, data on historical DACC-coated dressing use in various paediatric wounds, along with clinical outcomes, procedural information and tolerability were also analysed. RESULTS: A total of 240 paediatric patients (120 in each treatment group) were included, with mean ages of 6.5 years and 5.8 years for the DACC group and the SHF group, respectively. Significantly more patients reported resolution of infection in the DACC-coated group compared to the SHF group (94.8% versus 79.0%, respectively; p=0.05). There were significantly fewer wounds with no progress or deterioration in the DACC-coated dressings group compared to the SHF dressings group (mean no progress: 4.2 versus 13.5, p=0.03; and mean deterioration: 2.5 versus 7.5, p=0.005; respectively). Less time required for dressing changes and counselling as well as for dry removal was shown with DACC-coated dressings compared to SHF dressings. Microbiological examination showed numerous difficult-to-treat infections; frequently polymicrobial and including World Health Organization-priority pathogens. Furthermore, wider historical data from 1502 patients using DACC-coated dressings on various wound aetiologies was analysed. Findings showed that DACC-coated dressings were used under negative pressure wound therapy, and as part of strategies to prevent infection in incontinence associated dermatitis and neurological device wounds, as well as in the management of toxic epidermal necrolysis/Stevens-Johnson syndrome. Overall, the dressing was well tolerated, even in fragile skin, including neonatal and high-risk patients. CONCLUSION: The findings of this retrospective study support the use of DACC-coated dressings in complex paediatric wounds, particularly when infection control, antimicrobial stewardship, atraumatic removal, pain control and preservation of fragile skin are clinical priorities.