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Source: http://www.cidrap.umn.edu/news-persp...hip-wound-care
Experts offer guidance for antibiotic stewardship in wound care
Filed Under:
Antimicrobial Stewardship
Chris Dall | News Reporter | CIDRAP News
| Jul 28, 2016
An international group of experts on infectious diseases has published new guidance on reducing antibiotic use, and promoting stewardship, in the treatment of wounds. The position paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association, while not an official set of recommendations, is an effort to establish standards for diagnosing and treating clinically infected wounds and to incorporate antimicrobial stewardship structures into the daily practice of managing wound care.
The authors suggest that although the evidence is limited, applying principles of antimicrobial stewardship to wound care?one of the most common reasons for antibiotic use in hospitals?should help reduce unnecessary use of antimicrobials. The paper was published this week in the Journal of Antimicrobial Chemotherapy.
Why wound care? Because, the authors write, skin and soft issue infections are commonly treated with antibiotics, yet there are no guidelines for prudent antimicrobial use in wound treatment.
For example, clinicians will often keep patients on antibiotics until an infected wound is healed, even though there is no evidence to support this belief. In addition, some wounds that appear inflamed might not be infected at all. There's also patient expectation of treatment with antibiotics. All these factors can drive overuse of antibiotics, and ultimately lead to antibiotic-resistant infections.
'Pragmatic, expert, and informed'
"The drivers for antimicrobial misuse are diagnostic uncertainty, clinical ignorance of when and when not to treat with antibiotics, clinician fear, and patient demands," Dilip Nathwani, OBE, honorary professor of infection at the University of Dundee and president of the British Society for Antimicrobial Chemotherapy, told CIDRAP News. "The paper tries to provide potential solutions to all these areas."
Nathwani called the paper a "pragmatic, expert, and informed guidance" on current challenges in wound care treatment, and he said it was the first effort to address antibiotic stewardship in this clinical area.
The paper presents an overview of antimicrobial stewardship in wound care that includes four main elements:
The authors also suggest that, when possible, wound care should be guided by an interdisciplinary team of specialists dedicated to antimicrobial stewardship (an AMS team) working in conjunction with a wound care team.
In addition, they note that clinicians must educate patients?some of whom may expect antibiotics?on the risks of antibiotic therapy.
See also:
Jul 25 J Antimicrob Chemother position paper
Experts offer guidance for antibiotic stewardship in wound care
Filed Under:
Antimicrobial Stewardship
Chris Dall | News Reporter | CIDRAP News
| Jul 28, 2016
An international group of experts on infectious diseases has published new guidance on reducing antibiotic use, and promoting stewardship, in the treatment of wounds. The position paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association, while not an official set of recommendations, is an effort to establish standards for diagnosing and treating clinically infected wounds and to incorporate antimicrobial stewardship structures into the daily practice of managing wound care.
The authors suggest that although the evidence is limited, applying principles of antimicrobial stewardship to wound care?one of the most common reasons for antibiotic use in hospitals?should help reduce unnecessary use of antimicrobials. The paper was published this week in the Journal of Antimicrobial Chemotherapy.
Why wound care? Because, the authors write, skin and soft issue infections are commonly treated with antibiotics, yet there are no guidelines for prudent antimicrobial use in wound treatment.
For example, clinicians will often keep patients on antibiotics until an infected wound is healed, even though there is no evidence to support this belief. In addition, some wounds that appear inflamed might not be infected at all. There's also patient expectation of treatment with antibiotics. All these factors can drive overuse of antibiotics, and ultimately lead to antibiotic-resistant infections.
'Pragmatic, expert, and informed'
"The drivers for antimicrobial misuse are diagnostic uncertainty, clinical ignorance of when and when not to treat with antibiotics, clinician fear, and patient demands," Dilip Nathwani, OBE, honorary professor of infection at the University of Dundee and president of the British Society for Antimicrobial Chemotherapy, told CIDRAP News. "The paper tries to provide potential solutions to all these areas."
Nathwani called the paper a "pragmatic, expert, and informed guidance" on current challenges in wound care treatment, and he said it was the first effort to address antibiotic stewardship in this clinical area.
The paper presents an overview of antimicrobial stewardship in wound care that includes four main elements:
- Antibiotic therapy should be prescribed only for wounds that are clinically infected. While virtually all open wounds are colonized by bacteria, only wounds that show the classic signs of inflammation should be diagnosed as infected.
- Once the diagnosis of clinical infection has been made, immediate empiric antibiotic therapy should be based on the severity of the infection and available clinical and microbiological data.
- All clinically infected wounds should be cultured to determine the pathogen causing the infection and its susceptibility to antibiotics. This finding should then guide selection of further antibiotic treatment (if it is necessary) that's more narrowly focused.
- Antibiotic treatment should be administered for the shortest duration possible.
The authors also suggest that, when possible, wound care should be guided by an interdisciplinary team of specialists dedicated to antimicrobial stewardship (an AMS team) working in conjunction with a wound care team.
In addition, they note that clinicians must educate patients?some of whom may expect antibiotics?on the risks of antibiotic therapy.
See also:
Jul 25 J Antimicrob Chemother position paper