Antimicrobial Stewardship

Antibiotics have been a source of increasing concern and subsequent regulation among providers, especially those within wound care. Antimicrobial stewardship has been emphasized within the medical system in recent years as antibiotic-resistant organisms have increased globally and among at-risk patient populations.

Antibiotics have been a source of increasing concern and subsequent regulation among providers, especially those within wound care. Antimicrobial stewardship has been emphasized within the medical system in recent years as antibiotic-resistant organisms have increased globally and among at-risk patient populations.

The discovery of antibiotics has been associated with extending the human lifespan by 23 years. This phenomenon began in the 1900s and peaked in the 1950s, known as the "golden era" of antibiotics due to the rapid release of new antibiotic classes coupled with limited resistance. However, the gradual increase in antimicrobial resistance and associated infectious disease morbidity and mortality threatens to return the world to a post-antibiotic state where routine surgeries and minor infections become life-threatening.

Antimicrobial: The property pertaining to any of several categories of agents that are intended to be toxic to pathogenic organisms, including antibacterials, antiprotozoals, antifungals, and antiparasitics.

On the surface, topical antibiotics may appear to be a safe choice for some wounds, even some infected wounds, when compared to oral or intravenous options. A seemingly less dangerous adverse effect profile, less invasive nature, and potential for cost-effectiveness are logical, appealing features of topical antibiotics. However, a closer look reveals that the choice is not that simple, and, in fact, clinicians must take several points into consideration.

It is well known that chronic and hard-to-heal wounds have created a global crisis. Delayed healing in these wounds is often associated with biofilm, and antimicrobial dressings can be effective in managing bioburden in chronic wounds. For the use of antimicrobial advanced wound care dressings to be successful in chronic wound care, however, clinicians must have practical knowledge of dressing formats and options, dressing indications and applications, the principles of antimicrobial stewardship, and care planning for specific wound types.

Centuries ago, science took a back seat to superstition. Infectious diseases were seen as a sign of supernatural powers or the wrath of God. We now know that it was smallpox that led to the downfall of the Aztecs. We also know that bubonic plague was not a divine punishment, but it was caused by bacteria transmitted by fleas on rodents traveling on trading ships.

Antibiotic resistance is a growing health threat, not just in the United States, but throughout the world. Health care professionals are facing problems with antibiotic resistance, as well as with resistance to other antimicrobial agents. The Centers for Disease Control and Prevention (CDC) noted in 2019 that “more than 2.8 million antibiotic-resistant infections occur in the United States (US) each year, and more than 35,000 people die as a result.” The CDC lists 18 current threats, with three on the watch list as emerging causes of antibiotic resistance. Many of the bacteria on this threat list are found in chronically stalled wounds. Therefore, wound clinicians must be good stewards of antimicrobial treatments to prevent contributing to an already worsening problem.

Treatment of chronic and complex wounds complicated by biofilm formed by pathogens remains a tremendous challenge for the health care industry. Recent increases in infections mediated by drug-resistant bacterial and fungal pathogens highlight the need for new antimicrobial therapies. The application of topical agents with antimicrobial and antiseptic properties is gaining traction as an alternative to antibiotic prescriptions.

Antibiosis: The biological relationship between two organisms in which one living organism kills another to ensure its existence.

Antimicrobial resistance: The process that occurs when bacteria, fungi, and parasites (microorganisms) change over time and no longer respond to antimicrobial medications. This resistance makes it more difficult to treat infections and increases the risk of spreading diseases that result in severe illness and death.

Antimicrobial stewardship plan: An antimicrobial stewardship plan should seek to prevent wound infection in the first place and should promote ideal antibiotic use in clinically infected patients while also preventing use of antibiotics in non-infected patients.