Objective The aim of this narrative review is to examine the historical evolution of antimicrobial treatments, the rise of antimicrobial resistance (AMR) and the implementation of antimicrobial stewardship (AMS) over time. It explores whether AMR remains a concern in wound care, the development of new antibiotics and alternative antimicrobial therapies, and the benefits observed following AMS initiatives.
Materials and methods The Medline (PubMed) electronic literature database was searched for the relevant studies. The search revealed 2940 potential articles, screening for relevance identified 203 articles, which were reviewed.
Results Despite the emergence of AMS strategies, our review found that AMR remains a significant issue with regard to wound care and healthcare more generally. AMR is an increasing problem with resistance being widespread and being seen in non-antibiotic antimicrobials, such as silver. The identification of new antibiotics is lacking and, despite the development of newer treatments with current antibiotics (including combination therapies), there is a strong push for new, non-antibiotic therapies, such as photodynamic therapy and phage therapy.
Conclusion Alongside the development of new treatments, updating current AMS procedures and enhancing their implementation (resulting in a reduction in antimicrobial use) are identified as important areas in the battle against AMR. In addition, the implementation of AMS procedures corresponded with a decrease in levels of antimicrobial resistant microorganisms. As well as reducing levels of resistant microorganisms, this review revealed additional benefits of the introduction of AMS procedures, including a reduction in costs (surgical antibiotic prophylaxis costs), and a reduction in patient morbidity and mortality.