Antimicrobial Resistance in Wound Care. Rethinking Infection Management for an AMR Smart Future.

Antimicrobial resistance (AMR) is a top global health threat, with the World Health Organization (WHO) ranking it among the most urgent priorities. In wound care, chronic and hard-to-heal wounds often harbor resistant bacteria, and up to 60%¹ contain biofilms, making infections harder to treat.

Wound infection often leads to overuse and misuse of antimicrobials that can lead to resistant strains of bacteria, making infections harder or even impossible to treat.² Yet amid this looming challenge lies one of the most overlooked opportunities in wound care today: Shifting from reactive, antibiotic first habits to proactive, non cytotoxic bioburden management—without adding to the AMR burden.

Lancet infographic – AMR Series

Wound care sits at the intersection of infection prevention, antimicrobial stewardship, and patient centered healing. But too often, clinicians reach reflexively for systemic antibiotics or chemically active antimicrobial dressings simply because “that’s what we’ve always done.” It’s time to challenge that status quo.

Why the Old Way Isn’t Working

Chronic wounds are biologically complex ecosystems. Traditional antimicrobials add chemical burden, can trigger cytotoxicity, may inhibit growth factors, and contribute to resistance pressure. Up to 40% of chronic wounds develop infection³—driving delayed healing, increased care costs, and overreliance on antibiotics. 

The Non Cytotoxic Revolution: Essity’s Antimicrobial Resistance (AMR) aligned alternatives

While antimicrobial stewardship (AMS) emphasizes limiting unnecessary antibiotic use, clinicians still need effective ways to manage microbial burden and aid in infection prevention. Non-antibiotic, resistance-free technologies can play a critical role in this balance, helping control pathogens, disrupt biofilms, and support healing without adding to the AMR crisis. 

Two proven options are Cutimed^® Sorbact^® and Hydrofera Blue^®, each offering unique mechanisms that align with AMS strategies:

Sorbact^® Technology – Dressings are lined with DACC (dialkyl carbamoyl chloride), a hydrophobic fatty acid derivative that removes bacteria by irreversibly binding them to its surface without releasing active substances into the wound. Therefore, antimicrobial resistance is not expected.

Hydrofera Blue^®– The unique antibacterial approach of Hydrofera Blue® Combines methylene blue and gentian violet to target biofilms and gram-positive bacteria without using traditional antibiotics.

The most overlooked opportunity is not a new molecule or a blockbuster drug. It’s a mindset shift from “Is this wound infected? Should we start antibiotics or reach for a chemical antimicrobial?” to “How can we proactively manage bioburden while preserving tissue, protecting the microbiome, and preventing AMR?”

Essity’s non cytotoxic technologies answer this question with:

• Bioburden reduction without chemical warfare    

• Mechanisms that do not generate resistance

• Holistic support of the wound microenvironment  

• Reduced need for systemic antibiotics

• Better patient comfort, faster healing, and cost efficiency

This is antimicrobial stewardship (AMS) in action—not as a restrictive guideline, but as a future focused clinical advantage.

Conclusion: Responsible microbial management is critical to slowing AMR. Integrating alternative solutions, like Hydrofera Blue® and Cutimed® Sorbact® dressings into wound care protocols aids in effective infection prevention and biofilm control, aligning with AMS best practices while preserving antibiotic effectiveness for the future.

1.Maillard JY, Kampf G, Cooper R. An¬timicrobial stewardship of antisep¬tics that are pertinent to wounds: the need for a united approach. JAC Antimicrob Resist. 2021;3(1):dlab027.doi:10.1093/jacamr/dlab027
2.World Health Organization (WHO). (2020). Global guidelines for the prevention of surgical site infection. Retrieved from https://www.who.int Oct 2025
3.Simel DL, Rennie D. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. Annals of Internal Medicine. 2009 May 5;150(9):659
4.Stanirowski PJ, et al. (2016b) Randomized controlled trial evaluating dialkylcarbomyl chloride impregnated dressings for the prevention of surgical site infections in adult women undergoing caesarean section. Surg Infect (Larchmt), 17(4): 427 35, 2016.