Antimicrobial resistance (AMR) is no longer a distant threat—it’s a daily reality in wound care. As resistant pathogens become more prevalent, healthcare professionals are being called to rethink how they manage infections. At the heart of this shift is antimicrobial stewardship (AMS), a proactive framework designed to preserve the effectiveness of antimicrobials while improving patient outcomes. Understanding the difference between AMR and AMS and how they interact is essential for anyone involved in wound management.
The AMR challenge in wound care
AMR occurs when microorganisms such as bacteria, viruses, fungi, and parasites evolve to resist the effects of antimicrobial drugs. In wound care, this resistance can lead to persistent infections, delayed healing, and increased risk of complications. Chronic wounds, like venous leg ulcers and diabetic foot ulcers are particularly vulnerable, often becoming breeding grounds for resistant organisms like Staphylococcus aureus (including MRSA), Pseudomonas aeruginosa, and Enterococcus species¹.
Globally, AMR is projected to cause 10 million deaths annually by 2050 if left unchecked². In wound care settings, this translates to longer hospital stays, higher treatment costs, and limited therapeutic options. The overuse and misuse of antibiotics, especially topical antimicrobials, has accelerated this crisis³.
Why AMS is more than a buzzword
Antimicrobial stewardship (AMS) is the strategic response to AMR. It encompasses a set of coordinated interventions designed to optimize the use of antimicrobials, ensuring the right drug, dose, duration, and route are used for each patient⁴. AMS aims to:
- Improve clinical outcomes
- Minimize adverse effects
- Reduce the emergence of resistance
- Lower healthcare costs
In wound care, AMS means more than just prescribing wisely. It involves early intervention and appropriate dressing selection, and ongoing reassessment of treatment plans. It also encourages the use of non-antimicrobial interventions when possible⁵ and responsible prescribing and use of antibiotics⁶ to avoid compromising care.
AMR vs AMS: Two forces shaping the future of wound management
While AMR represents the growing threat, AMS offers a structured solution. The two are intrinsically linked: poor stewardship accelerates resistance, while effective stewardship slows it down. Understanding this dynamic is crucial for wound care professionals.
For example, applying topical antibiotics “just in case” may seem harmless, but it can contribute to resistance and disrupt the wound’s microbiome⁷. AMS encourages clinicians to pause, assess, and choose interventions that align with evidence-based protocols.
How AMR is changing the way we treat wound infections
Traditional approaches to wound infection often rely heavily on antibiotics and antiseptics. However, the rise of resistant organisms has exposed the limitations of these methods. Biofilm-forming bacteria, for instance, are notoriously difficult to eradicate and often require more than antimicrobial agents alone⁸.
This shift has prompted a move toward smarter, targeted strategies, such as physical removal of bacteria, advanced wound dressings, and improved diagnostic tools. These approaches not only reduce infection risk but also support AMS by minimizing unnecessary antimicrobial exposure⁹.
AMS in action: Practical relevance for wound care practice
AMS in wound care isn’t theoretical. It’s highly practical and key strategies include:
- Infection prevention: Using aseptic techniques, dressings with non-active agents indicated for wound infection, and patient education to reduce contamination.
- Bioburden management: Monitoring signs of infection and using non-antibiotic methods to reduce bacterial load.
- Selective antimicrobial use: Reserving antimicrobials including antibiotics for confirmed infections and using them judiciously.
Multidisciplinary collaboration is essential. Nurses, physicians, pharmacists, and infection control specialists each play a role in implementing stewardship. Together, they can create protocols that balance efficacy with sustainability, ensuring patients receive the best care without contributing to the resistance crisis¹⁰.
Stewardship starts with awareness
AMR and AMS are two sides of the same coin- one a growing threat, the other a guiding principle. In wound care, where infection risk is high and treatment decisions are complex, understanding both is critical. By embracing AMS, clinicians can protect their patients, preserve antimicrobial efficacy, and contribute to a more sustainable future in healthcare.
Want to learn more about Antimicrobial Stewardship? Download the Wounds UK Best Practice Statement- Antimicrobial stewardship strategies for wound management publication: https://wounds-uk.com/best-practice-statements/best-practice-statement-antimicrobial-stewardship-strategies-wound-management/
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References
- European Wound Management Association (EWMA). Antimicrobial Stewardship in Wound Care. 2022. [link]
- O’Neill J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. 2016. [link]
- World Health Organization. Global Action Plan on Antimicrobial Resistance. 2015. [link]
- CDC. Core Elements of Hospital Antibiotic Stewardship Programs. 2019.
- International Wound Infection Institute (IWII) Wound Infection in Clinical Practice. Wounds International. 2022 [link]
- Blackburn, J., Ousey, K., Rippon, M., Rogers, A., Pastar, I., & Lev-Tov, H. (2025). Applying antimicrobial strategies in wound care practice: A review of the evidence. International Wound Journal, 22(5), 1234–1248. [link]
- NICE. Antimicrobial Prescribing Guidelines for Skin and Soft Tissue Infections. 2020.
- Bjarnsholt T. The Role of Bacterial Biofilms in Chronic Infections. APMIS. 2013. [link]
- Leaper D et al. Appropriate Use of Antimicrobials in Wound Management. JWC. 2017. [link]
- WHO. Toolkit for Antimicrobial Stewardship in Healthcare Settings. 2021. [link]