Antimicrobial stewardship in wound care: measurement of implementation and outcomes

The continuing development of antimicrobial resistance (AMR) is a growing global health threat characterised by the ability of microorganisms to withstand the effects of antimicrobial agents. AMR is of such global concern that the World Health Organization (WHO) has developed a global strategy called Antimicrobial Stewardship to combat this threat. This article presents a scoping review designed to identify what impact the introduction of the AMS has had on working practice. The results of the literature search identified 2458 potential articles, 13 articles identified from other sources, thus a total of 2471 articles to screen. Following screening 120 articles were identified for full-text review and finally 80 articles were retrieved and included in the narrative review. All studies indicated the introduction of specific AMS guidelines and/or protocols that affected treatment regimens with a reduction in surgical site infections and a reduction in antimicrobial resistance development being key clinical outcomes of the introduction of antimicrobial stewardship programmes. Forty percent of studies specifically indicating training/education and 43.8% studies indicating some form of audit/feedback as part of the AMSPs. Additionally, antimicrobial usage was reported in most studies resulting in a de-escalation of antimicrobial use (e.g., intravenous vs. oral, broad-or narrow-spectrum), changes in antimicrobial dosage or duration 25.0% and 46.3% respectively. Overall, this review demonstrates that implementation of AMS does have several positive clinical patient outcomes.