Podcast Episode 9: Antimicrobial Stewardship

Hello, and welcome to this podcast in association with the Leg Club. I'm Karen Uzzi, I'm Professor of Skin Integrity at the University of Huddersfield in Yorkshire, and I'm going to be talking to you today about antimicrobial resistance and why it's so important that we understand But first of all I want to just discuss what is antimicrobial resistance and this is when organisms that cause infection evolve in ways that they can survive treatments. So by that I mean it's those super bugs that we see that whichever antibiotics we use or antimicrobials these bugs have become resistant to them and can no longer kill them. And why is it so important? Well if If we don't do anything about combating antimicrobial resistance now, by 2050, it's estimated we'll have in excess of 10 million deaths caused directly as a result of antimicrobial resistance. So that's why it's so important we understand it now and we're able to start doing things that can help prevent this. And this antimicrobial resistance actually affects wounds as well and the care we give to wound management. And we know that wounds can be a source of infection because it allows entry of microorganisms into the body, including these antibiotic, antimicrobial resistant bacteria. And any damage to the skin is classed as a wound. So this is why we need to be so careful and we must ensure that when we look at wounds, we're able to assess and diagnose whether or not they are actually infected. So do they need an antibiotic or do they need an antimicrobial? And antimicrobial resistance isn't new. Over the past couple of decades, all the countries in the world have been talking about it and saying that we really need to implement ways of managing it. And the World Health Organization in 2015 actually produced their global action plan on antimicrobial resistance. The UK government has also published all their documents that relate to antimicrobial resistance and how do we manage it. And as we all know, we're in the middle of a pandemic at the moment and the Global Alliance for Infections in Surgery have actually published their documents, COVID-19 lessons for the fight against antimicrobial resistance. So we were concerned about it pre-pandemic and we're still concerned about it peri-pandemic And we'll actually be concerned about it post-pandemic as well. You may also be thinking, well, should we really be concerned? We've got lots of antibiotics that we can use. But actually, it's been 30 years since a new class of antibiotic was introduced. Researchers across the world are currently looking at new antibiotics. But at this moment in time, we're so relying on the antibiotics that we know as penicillins or tetracyclines, for example. So it's important that we use them only when actually needed. And similar with our antimicrobial wound dressings, we should be using them when they're needed for an infected wound. And within wound care, Julian Guest and his team identified that each year, 50% of all wounds in the community have had at least one course of antibiotic prescribed. So you can see it is a real issue. But what can we do about it? We need to be ensuring that clinicians, practitioners, patients and their carers fully understand what infection means and how do we actually identify an infected wound. So we need to make sure that we're not just looking at a wound and thinking, oh it looks red it must be infected. Has the patient got pyrexia? Is there excess exudate coming from that wound? Is it painful? Does the patient feel generally unwell? If they do and they've got these covert and overt signs of infection then yes we should be using our antibiotics and antimicrobials. If they're not and it's healing perfectly well and the patient feels well then we don't need them. But we do have antimicrobial stewardship and this is a great way of helping to reduce antimicrobial resistance. An antimicrobial stewardship is defined as an organizational or a healthcare system-wide approach to promoting and monitoring judicious or correct use of antimicrobials to preserve their future effectiveness. And as you can tell by that definition it's not just about the nurse or the healthcare professional, it's about everybody's business. So So antimicrobial stewardship is about everybody being aware of using antimicrobials in the most correct way possible and to look at which sort of antimicrobial should we be using. So it's everybody's job to find out what is available and when and how should you be using it. Also ensuring that everybody is able to identify an infected wound and documents it correctly as well. There are a lot of different publications out there at the moment that are worth going and having a look at if people want to know more about this area because this is only a short podcast. So I'd like to send you to look at the best practice statement on antimicrobial strategies for wound management. That was published by Wounds UK and is free to download from their website. There is also a position paper that's being published by Ben Lipskin and his team and it's entitled Antimicrobial Stewardship in Wound Care. It's published in association with the European Wound Management Association and the British Society for Antimicrobial Chemotherapy published in the Journal of Antimicrobial Chemotherapy. If you get a chance please do go and have a look at this because this is really clear. It says what we should be doing with antimicrobial stewardship particularly within wound management and it's the first of its kind. So in essence antimicrobial resistance is here now it's not a crisis waiting to happen it's a crisis that we're in the middle of. We need to understand it and we need to implement strategies such as antimicrobial stewardship but possibly most importantly we need to educate all members of the multidisciplinary team and patients and carers on what is an infected wound? What's the signs and symptoms of an infected wound? And when should we be using antimicrobials? Thank you all very much for listening. I hope you've enjoyed it and I hope you're able to go away and have a read of the documents that I suggested. Thank you. you