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

Lipsky, Benjamin A.; Dryden, Matthew; Gottrup, Finn; Nathwani, Dilip; Seaton, R Andrew; Stryja, Jan

doi:10.1093/jac/dkw287

Cited by 138 publications

(143 citation statements)

References 52 publications

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“…Finally, topical therapy may allow treatment with agents not currently available (or safe) for systemic therapy. These features all fit nicely with the tenets of antimicrobial stewardship for wounds [14]. Thus, a topical agent with the right spectrum of activity might be effective, either as primary therapy for a mild infection or as adjunctive therapy to systemic treatment for moderate or severe DFI.…”

Section: The Role Of Topical Antimicrobial Therapymentioning

confidence: 74%

“…Because infections of the foot are now among the most common serious complication of diabetes [13], and they are often associated with comorbidities such as peripheral neuropathy and arterial disease, specialized classification schemes were developed for DFI. The classification, devised in 2004 by the Infectious Diseases Society of America (IDSA) guidelines committee for DFIs, and adopted by the expert panel on infection of the International Working Group on the Diabetic Foot (IWGDF) [14, 15], both defines when a wound is infected and classifies the infection’s clinical severity. The scheme has achieved widespread acceptance internationally and has been validated in numerous studies [16–22].…”

Section: Classification Of Diabetic Foot Infectionsmentioning

confidence: 99%

See 1 more Smart Citation

A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

Lipsky

Silverman²,

Joseph

2016

Open Forum Infectious Diseases

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Schemes for classifying skin and soft tissue infections (SSTIs) pose limitations for clinicians and regulatory agencies. Diabetic foot infections (DFIs) are a subset of SSTIs. We developed and are proposing a classification to harmonize current schemes for SSTIs and DFIs. Existing schemes for classifying SSTIs are limited in both their usefulness to clinicians and to regulatory agencies. The guidelines on SSTI from the Infectious Diseases Society of America (IDSA) and the guidance from the US Food and Drug Administration do not adequately address many types of wound infections. However, guidelines developed by the IDSA for DFIs provide a classification scheme that has been validated and widely used. Diabetic foot infections are similar to SSTIs in pathophysiology, microbiology, and treatment and can be seen as a subset of SSTI. Thus, based on the documents noted above, and our review of the literature, we have developed a proposed classification scheme for SSTI that harmonizes well with the DFI classification. We believe this new scheme will assist clinicians in classifying most wound infections and potentially aid regulatory agencies in testing and approving new antimicrobials for these infections.

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Section: The Role Of Topical Antimicrobial Therapymentioning

confidence: 74%

Section: Classification Of Diabetic Foot Infectionsmentioning

confidence: 99%

A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

Lipsky

Silverman²,

Joseph

2016

Open Forum Infectious Diseases

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“…The decision to use targeted antimicrobials against obligate anaerobes by clinicians should be administered under the guidance of antimicrobial stewardship (Lipsky et al, 2016a, Lipsky et al, 2016b). The pattern of antimicrobial therapy prescribing in this study were based on specialist Infectious disease physicians with experience of managing these complex patients, but these results may reflect differently when managed by non-specialist clinicians with limited exposure to these wounds.…”

Section: Discussionmentioning

confidence: 99%

Next Generation DNA Sequencing of Tissues from Infected Diabetic Foot Ulcers

et al. 2017

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We used next generation DNA sequencing to profile the microbiome of infected Diabetic Foot Ulcers (DFUs). The microbiota was correlated to clinical parameters and treatment outcomes to determine if directed antimicrobial therapy based on conventional microbiological cultures are relevant based on genomic analysis. Patients ≥ 18 years presenting with a new Diabetic Foot Infection (DFI) who had not received topical or oral antimicrobials in the two weeks prior to presentation, were eligible for enrolment. Tissue punch biopsies were obtained from infected DFUs for analysis. Demographics, clinical and laboratory data were collected and correlated against microbiota data. Thirty-nine patients with infected DFUs were recruited over twelve-months. Shorter duration DFUs (< six weeks) all had one dominant bacterial species (n = 5 of 5, 100%, p < 0.001), Staphylococcus aureus in three cases and Streptococcus agalactiae in two. Longer duration DFUs (≥ six weeks) were diversely polymicrobial (p < 0.01) with an average of 63 (range 19–125) bacterial species. Severe DFIs had complex microbiomes and were distinctly dissimilar to less severe infections (p = 0.02), characterised by the presence of low frequency microorganisms. Nineteen patients (49%) during the study period experienced antimicrobial treatment failure, but no overall differences existed in the microbiome of patients who failed therapy and those who experienced treatment success (p = 0.2). Our results confirm that short DFUs have a simpler microbiome consisting of pyogenic cocci but chronic DFUs have a highly polymicrobial microbiome. The duration of a DFU may be useful as a guide to directing antimicrobial therapy.

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“…There is now rapidly gaining interest in AMS within wound care, and both consensus documents and guidelines have been published to help clinical professionals make appropriate decisions about antibiotic use . The wound care sector is unique in that there are also a wide range of topical antiseptics available to help both treat and prevent infections locally.…”

Section: Ams In Wound Carementioning

confidence: 99%

“…In wound management, it is imperative that all antimicrobial interventions are used wisely. Some have proposed that these antiseptic agents should be included as an integral part of AMS decisions, and the same rules should apply in terms of use on appropriate wounds, at appropriate concentrations to ensure rapid kill, and use for appropriate time periods . To date, the emergence of resistance to antiseptics, some of which have been used for centuries, has in no way reached the epidemic proportions seen with antibiotic use over a period totalling less than 100 years.…”

Section: Ams In Wound Carementioning

confidence: 99%

Appropriate use of dressings containing nanocrystalline silver to support antimicrobial stewardship in wounds

Woodmansey

Roberts²

2018

International Wound Journal

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Antimicrobial resistance is an ever-increasing global concern, with the era of untreatable infection becoming a reality. Wound care is no exception, with increasing issues of antibiotic-resistant infections across different wound types and care settings. Antibiotic resistance and stewardship have been the priority for most strategic interventions so far; however, in wound care, alternative or supplementary strategies using antiseptics should be considered. Antiseptics such as silver can provide effective cidal activity across a broad range of wound pathogens, assuming they are used at the correct level for an appropriate duration. Evidence summarised in this manuscript suggests that effective antiseptics, such as nanocrystalline silver, have an increasing body of evidence in support of their use to minimise transmission of antibiotic-resistant organisms as part of institutional infection control procedures and, in addition, through appropriate early use and stewardship on local wound infections, in conjunction with local procedures, to minimise the need for systemic antibiotic therapy. Engagement, alignment, and collaboration between wound care professionals and wider related teams and governments on antimicrobial stewardship, and the potential role of antiseptics within this, will help to generate further evidence for such interventions in the fight against antimicrobial-resistant infections in wound care.

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

Abstract: 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.

Cited by 138 publications

References 52 publications

A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

Next Generation DNA Sequencing of Tissues from Infected Diabetic Foot Ulcers

Appropriate use of dressings containing nanocrystalline silver to support antimicrobial stewardship in wounds

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