Impact of increasing antimicrobial resistance on wound management.

Wound infection with antimicrobial-resistant bacteria may result in prolonged debility of the patient and increased healthcare costs. Avoidance of the development of resistance therefore needs increasing attention in the management of patients with wound infections. Antimicrobial use is the major determinant in the development of resistance. Knowledge of the criteria for wound infections, the causative pathogens, and their prevailing susceptibility patterns is a prerequisite for the rational prescribing of antimicrobials. Since the benefits of wound debridement and wound irrigation have been proven, prescribing antibacterials should not usually be the initial treatment strategy in the management of infected wounds. The use of systemic antibacterials is only indicated when infection appears to be spreading through the subcutaneous soft tissues and in cases of ascending limb infection or severe sepsis. To minimize the selection pressure of individual antibacterials on the normal flora of the skin and gut, narrow-spectrum agents are to be preferred. Empirical treatment with systemic antibacterials should be adapted, based on the results of wound cultures. Topical antibacterials have also been successfully used in the management of patients with infected wounds. Defining guidelines for the rational use of systemic and topical antimicrobials is an important tool to limit and control the development of resistance. Because of geographical differences in resistance rates and methodological differences in published reports, local surveillance data should be available to assist clinicians in the development of these guidelines. New systemic and topical agents should be assessed at an early stage of development for their potential for selection of resistance. Research is needed on the applicability of alternatives to antimicrobials in the management of patients with wound infections in order to reduce the future risk of antimicrobial resistance.