Antimicrobial stewardship in wound care: a Position Paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association

  • B A Lipsky University of Oxford
  • M Dryden Hampshire Hospitals Foundation NHS Trust
  • F Gottrup Bispebjerg University Hospital
  • D Nathwani University of Dundee
  • R A Seaton Queen Elizabeth University Hospital
  • J Stryja Educational and Research Institute AGEL
Keywords: antimicrobial stewardship, wound care

Abstract

Background: With the growing global problem of antibiotic resistance it is crucial that clinicians use antibiotics wisely, which largely means following the principles of antimicrobial stewardship (AMS). Treatment of various types of wounds is one of the more common reasons for prescribing antibiotics.

Objectives: This guidance document is aimed at providing clinicians an understanding of: the basic principles of why AMS is important in caring for patients with infected wounds; who should be involved in AMS; and how to conduct AMS for patients with infected wounds.

Methods: We assembled a group of experts in infectious diseases/clinical microbiology (from the British Society for Antimicrobial Chemotherapy) and wound management (from the European Wound Management Association) who, after thoroughly reviewing the available literature and holding teleconferences, jointly produced this guidance document.

Results: All open wounds will be colonised with bacteria, but antibiotic therapy is only required for those that are clinically infected. Therapy is usually empirical to start, but definitive therapy should be based on results of appropriately collected specimens for culture. When prescribed, it should be as narrowly focused, and administered for the shortest duration, as possible. AMS teams should be interdisciplinary, especially including specialists in infection and pharmacy, with input from administrative personnel, the treating clinicians and their patients.

Conclusion: Available evidence is limited, but suggests that applying principles of AMS to the care of patients with wounds should help to reduce the unnecessary use of systemic or topical antibiotic therapy and ensure the safest and most clinically effective therapy for infected wounds.

Author Biographies

B A Lipsky, University of Oxford

Division of Medical Sciences, Green Templeton College, University of Oxford, United Kingdom and University of Washington, United States of America

M Dryden, Hampshire Hospitals Foundation NHS Trust

Department of Microbiology and Infection, Hampshire Hospitals Foundation NHS Trust, United Kingdom

F Gottrup, Bispebjerg University Hospital

CopenhagenWound Healing Center, Bispebjerg University Hospital, Denmark

D Nathwani, University of Dundee

Ninewells Hospital and Medical School, University of Dundee, United Kingdom

R A Seaton, Queen Elizabeth University Hospital

Queen Elizabeth University Hospital, United Kingdom

J Stryja, Educational and Research Institute AGEL

Department of Science and Research, Educational and Research Institute AGEL,  Czech Republic

Published
2020-08-03
Section
General Review