Antimicrobial stewardship strategies for wound management: Recommendations for the UK

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Antimicrobial stewardship strategies for wound management: Recommendations for the UK

Jacqui Fletcher, Tom Ashfield, Jeannie Donnelly, Valerie Edwards-Jones, Sian Fumarola, Heather Hodgson, Cheryl Lugton, Karen Ousey, Joy Tickle
4 November 2025

Antimicrobial resistance (AMR) is a global crisis. The World Health Organization (WHO) has identified AMR as one of the top ten global public health threats, with significant implications for achieving the Sustainable Development Goals (WHO, 2023). Naghavi et al (2024) predict a 68% increase between 2019 and 2050 in deaths attributed to bacterial AMR alone, with AMR-associated deaths increasing by 75% between 2021 and 2050, leading to approximately 8.22 million deaths in 2050 (Naghavi et al., 2024). Projections indicate that, by 2050, rising treatment costs for bacterial infections could push approximately 28.3 million people into extreme poverty, a number that highlights the danger of both a global humanitarian crisis and damage to the world economy (WHO, 2015). 

In the words of Dame Sally Davies, the UK Special Envoy for AMR: ‘The data already shows that more people are dying of AMR than of climate change every year, and it’s going to get worse’. (ITN-Business, 2023)  

To manage this urgent and rising global threat, global health authorities including the WHO, the Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC) have implemented strategic frameworks to combat AMR. 

In wound care, AMR presents a great challenge for acute, chronic and surgical wounds, especially in immunocompromised patients and those with frequent exposure to the hospital environment (Bassetti et al., 2025). Recent studies have indicated that up to 20% of wound microbes may have developed AMR (Mardourian et al., 2023, Guan et al., 2021). The risk of AMR presents a particular concern in chronic wounds due to the vulnerability to infection and the presence of complex microbial communities. 

Timely and accurate diagnosis of wound infections is critical to guide appropriate interventions and reduce unnecessary antimicrobial use, thereby reducing the risk of resistance. Antimicrobial stewardship (AMS) strategies are key to reducing the risk of AMR. The National Institute for Health and Care Excellence (NICE) define AMS as an organisational or healthcare system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness (NICE, 2025a). 

AMS is everybody’s responsibility, including all healthcare professionals (HCPs), patients and carers, and should be assessed through measurable outcomes such as surveillance and audit. It is paramount that all healthcare professionals and organisations remain informed, and act upon relevant local and national policies and guidelines. A collaborative approach is essential to the success of AMS, with healthcare professionals, support staff, patients, families and carers each playing a vital role in mitigating the impact of AMR. Central to this effort is the prevention of wound infection, which should prioritise the use of products that minimise infection risk without contributing to the development of resistance.

This document is an updated second edition of the 2020 Best Practice Statement on AMS in wound care (Wounds UK, 2020). This new edition is based on updated evidence and the discussions from an expert panel meeting on 10 July 2025. This publication aims to highlight the escalating global and national threat of AMR and its relevance to UK wound care professionals, patients and carers. It presents targeted strategies to support AMS within wound care practice. By revisiting the foundational principles of wound management, the publication offers essential definitions and actionable guidance that healthcare professionals must understand to effectively implement AMS approaches. It also explores the critical role of multidisciplinary team (MDT) collaboration in wound care and its influence on both AMR reduction and AMS optimisation.

The fast response of the healthcare professionals and organisations to the COVID-19 pandemic demonstrated the speed with which scientific evidence can be collected and published in a time of crisis. In addition to the dearth of evidence regarding the extent of AMR in wound infections, AMS in wound care is rarely, if ever, mentioned in AMR policy publications. 

Throughout this document, we have highlighted ‘action statements’, making this document an urgent call to action to address these unmet needs and highlight the significant danger of AMR that patients with wounds are increasingly facing within the UK and globally. 

Jacqui Fletcher (Chair)

Click here to download a checklist for practicing AMS in wound care

Download the PDF below to access the full Best Practice Statement

Disclaimer: This document has been developed by Wounds UK and is supported by an unrestricted educational grant from Essity.
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