References
Antimicrobial stewardship in wound care
Abstract
Strategies to tackle the global crisis of antimicrobial resistance include implementing antimicrobial stewardship across the healthcare and agricultural sectors. Many clinical specialities have developed policies to advise practitioners on how to prescribe antibiotics more effectively, but there is still a lack of data on the impact of this change. Overuse and misuse of antibiotics have been commonplace since their introduction 70 years ago, and have contributed to the development of the resistance seen today. There is a dearth of new antibiotics and, if nothing is done to restrict the use of those that remain effective, there is a risk of returning to the pre-antibiotic era where simple infections could result in death. In wound care, it is essential that antibiotic treatment is appropriate to reduce infections. Many medical conditions predispose people to wounds that are difficult to heal and become chronic unless the underlying causes are addressed. Most wound infections are caused by bacteria, which are becoming increasingly resistant to commonly used antibiotics. This necessitates strict regimens for managing infection, which include prescribing antibiotics only when they are essential. Antimicrobial stewardship is undertaken in all UK healthcare facilities, and local advisory committees oversee the prudent use of antibiotics and other antimicrobial agents to try to prevent further increases in resistance. National guidance has been produced but whether full compliance has been followed has yet to be established and the impact of implementation needs to be analysed.
It has been estimated that 2.2 million wounds are treated in the UK each year, costing the NHS more than £5 billion (Guest et al, 2015). GP and nursing time accounts for the majority of the costs, but it is estimated that approximately £1.39 billion is spent on antibiotics. Many patients present with chronic wounds (about 60%) with some remaining unhealed after 12 months (Guest et al, 2017). Many conditions can predispose people to wounds that are difficult to heal and these can become chronic unless the underlying causes are addressed. As an example, people with diabetes have a high incidence of wounds on their feet, which can be hard to heal (Vowden, 2011).
Modern molecular techniques have shown that more than 80% of chronic wounds are colonised with biofilm (an aggregate of microorganisms embedded within a self-produced matrix of extracellular polymeric substances attached to the wound tissues) (Malone et al, 2017). Biofilm prevents healing (Wolcott et al, 2008), and has a protective function, which renders wounds unresponsive to topical and/or systemic antimicrobial treatment (Costerton et al, 1981).
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