European Union Antibiotic Awareness Day Relevance for Wound Care Practitioners

Abstract

The European Centre for Disease Prevention and Control (ECDC) has marked the 18 November 2010 as this year's European Union Antibiotic Awareness Day (EAAD) to improve knowledge in the use of antibiotics for clinicians in both primary and secondary care, their patients and the public in general. The event has been developed through partnership and with the support of the European Union Health Networks and professional organisations, including the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the Standing Committee of European Doctors (CPME). This EAAD is highly relevant to wound care practitioners, their patients and carers, and deserves interest and attention. The website and relevant materials are available and downloadable on: ecdc.europa.eu/en/EAAD/ Pages?home.aspx/ All of us are aware that antibiotic resistant and emergent bacteria have become a major complication to clinical practice and that prudent antibiotic stewardship and guidelines are sometimes lacking or overlooked. The open chronic wounds we treat harbour a reservoir of pathogens, such as Pseudomonas spp. and β haemolytic Streptococcus, and also resistant organisms, such as meticillin resistant Staphylococcus aureus. It is all too easy to swab these wounds and, when sensitivities are given in microbiological reports, to inappropriately start antibiotics when antiseptics can do as well. This relates to the increasingly accepted but as yet poorly defined ‘critical colonisation’ or ‘pre-infection’ of open wounds, where the species and numbers of colonising organisms risk invasive infection with cellulitis, lymphangitis and lymphadenopathy, bacteraemia and sepsis if unrecognised or untreated. This progression of infection does justify antibiotic therapy, which may need intravenous administration not necessarily needing admission if out patient or primary care IV therapy is available. The importance of including patients, as well as their carers, in this process is that 80% of antibiotic prescribing is community based. Clinicians may be pressed to prescribe antibiotics because of ‘patient pressure’ when there is not a medical need. However, our patients do die with multiple organ failure following sepsis, often hastened or worsened because of poor underlying nutrition and major co-morbidities, and must not be denied early and adequate antibiotics when indicated. Alternative early interventions are available to manage persisting or progressing colonisation with an exceptional array of topical antiseptic and dressing therapies: time honoured antiseptics such as chlorhexidine and povidone-iodine, are now joined by silver and polyhexamethylene biguanide (polihexanide) and technology involving several methods of debridement and negative pressure therapy. Chronic wound care and infection has been the target of considerable interest which has led to many original articles published in the International Wound Journal and other journals, with several consensus documents, including one endorsed by the World Union of Wound Healing Societies. The objective of the EAAD is to prevent unnecessary antibiotic use through development and dissemination of educational evidence-based educational materials aimed at national level. The awareness day on the 18 November this year is the third annual event of its type. It has been associated with several additional activities in many European countries and involved the European Parliament as well as the Department of Health in the UK and the Advisory Committee on Antimicrobial Resistance and healthcare Associated Infection (ARHAI), of which the author of this Editorial is a member. The ECDC hospital providers' toolkit asks several key questions: What is the problem? How does the use of antibiotics contribute to the problem? Why promote prudent use of antibiotics? How to promote prudent use of antibiotics? The questions are cogently answered and are just as relevant to clinicians who prescribe antibiotics in the field of wound care; the key, modified, answers being: the emergence, selection and spread of resistant bacteria is a threat to patient safety infections with antibiotic resistant bacteria result in increased patient morbidity and mortality, as well as increased need for hospitalisation and length of care misuse of antibiotics is a factor which drives development of antibiotic resistance. It would be timely to have the EAAD taken up by wound practitioners and have it become part of care plans and introduced through further publications and wound healing societies. ProfessorDavid Leaper 1