Volume 24 Number 1

In November 2022 the European Wound Management published an up-date of the Antimicrobials and non-healing wounds document by Probst et al¹. This document aims to provide an update on existing knowledge on antimicrobials, including a general clinical approach to prescribing antimicrobials. It is not a guideline document and does not deal with particular topical products with antimicrobial agents. It was developed firstly for health care professionals, who are in direct wound care and secondly for researchers, who may derive ideas for future investigation.

With this document the authors provide a narrative review giving an overview of the literature about antimicrobial stewardship published since 2013. The included studies show that there is some new research available about biofilm, new technologies for the early diagnosis of wound infection and the evaluation of the effectiveness of antimicrobial dressings against wound bacteria or fungi. However, the studies are difficult to compare because of the use of various primary endpoints, different data collection methods or a low sample size making it difficult to generalise the results. This can be one reason why it is difficult for clinicians to draw recommendations on the appropriate use of topical antimicrobial treatment for wound care.

We therefore recommend to support improved uniformity and comparability of clinical studies, the standardisation of the primary endpoints such as prevention of clinical infection, clinical resolution of infection or resolution of a wound infection. Additionally, the study design should be positioned in the upper level of the evidence-pyramid using a more rigorous methodology hence to minimise the effect of bias on the results. This would provide clinicians a level of clarity and support to better understand the magnitude of antimicrobial stewardship and to help deciding the best currently available topical antimicrobial treatment for wound care. Obviously, evidence-based and cost-effective antimicrobial dressings play an important role in reducing the use of systemic antibiotics, but current evidence is not strong enough e.g. to give superiority from one antimicrobial dressing to another.

Author(s)

Sebastian Probst*^1-4 DClinPrac, MNS, RN, Kirsi Isoherranen⁵ MD PhD
¹School of Health Sciences HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
²Care Directorate, University Hospital Geneva, Switzerland
³Faculty of Medicine Nursing and Health Sciences Monash University, Melbourne, Australia
⁴College of Medicine Nursing and Health Sciences University of Galway, Galway, Ireland
⁵Helsinki University Hospital/Skin and Allergy Hospital, Meilahdentie 2, 00029 HUS, Finland

*Corresponding author email sebastian.probst@hesge.ch

References

1. Probst S, Apelqvist J, Bjarnsholt T, Lipsky BA, Ousey K, Peters EJG. Antimicrobials and Non-healing Wounds: An Update. J Wound Management, 2022;23(3 Sup1):S1-S33. DOI:10.35279/jowm2022.23.03.sup01