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Impact of increasing antimicrobial resistance on wound management
P Margreet G Filius1, Inge C Gyssens
1Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands. filius@bacl.azr.nl
Abstract:
Wound infection with antimicrobial-resistant bacteria may result in prolonged debility of the patient and increased healthcare costs. Avoidance of the development of resistance therefore needs increasing attention in the management of patients with wound infections. Antimicrobial use is the major determinant in the development of resistance. Knowledge of the criteria for wound infections, the causative pathogens, and their prevailing susceptibility patterns is a prerequisite for the rational prescribing of antimicrobials. Since the benefits of wound debridement and wound irrigation have been proven, prescribing antibacterials should not usually be the initial treatment strategy in the management of infected wounds. The use of systemic antibacterials is only indicated when infection appears to be spreading through the subcutaneous soft tissues and in cases of ascending limb infection or severe sepsis. To minimize the selection pressure of individual antibacterials on the normal flora of the skin and gut, narrow-spectrum agents are to be preferred. Empirical treatment with systemic antibacterials should be adapted, based on the results of wound cultures. Topical antibacterials have also been successfully used in the management of patients with infected wounds. Defining guidelines for the rational use of systemic and topical antimicrobials is an important tool to limit and control the development of resistance. Because of geographical differences in resistance rates and methodological differences in published reports, local surveillance data should be available to assist clinicians in the development of these guidelines. New systemic and topical agents should be assessed at an early stage of development for their potential for selection of resistance. Research is needed on the applicability of alternatives to antimicrobials in the management of patients with wound infections in order to reduce the future risk of antimicrobial resistance.
Insights
Antimicrobial resistance in wound infections increases patient debility and healthcare costs. Rational antimicrobial use, prioritizing narrow-spectrum agents and alternatives, is crucial to combat resistance development.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Antimicrobial resistance (AMR) in wound infections poses a significant threat, leading to prolonged patient debility and increased healthcare expenditures.
- Antimicrobial use is the primary driver for the development of resistance, necessitating careful management strategies.
Purpose of the Study:
- To emphasize the importance of rational antimicrobial prescribing in managing wound infections.
- To highlight strategies for limiting the development and spread of antimicrobial resistance in wound care.
Main Methods:
- Review of current practices in wound infection management.
- Analysis of the role of antimicrobial stewardship in preventing resistance.
- Discussion of evidence-based guidelines for antimicrobial use in infected wounds.
Main Results:
- Debridement and irrigation are primary interventions; systemic antimicrobials are reserved for spreading infections or sepsis.
- Narrow-spectrum antimicrobials are preferred to minimize selection pressure on microbial flora.
- Local surveillance data is essential for developing effective antimicrobial guidelines.
Conclusions:
- Rational antimicrobial use, including guideline development and consideration of alternatives, is key to controlling resistance.
- Early assessment of new antimicrobial agents for resistance potential is vital.
- Further research into non-antimicrobial alternatives for wound infection management is needed.