In wound care, two terms are shaping the future of infection management: antimicrobial resistance (AMR) and antimicrobial stewardship (AMS). While they sound similar, they represent very different – but closely connected – concepts.
AMR refers to the microorganisms, like bacteria, that resist the drugs designed to kill them, making infections harder to treat and threatening patient safety. AMS is a knowledge-based set of practices specifically aimed at educating the use of antimicrobials responsibly to slow antibiotic resistance and to protect their long-term effectiveness.
Understanding what AMR is, why it matters, and how AMS works to combat it is critical for everyone involved in wound care. This article will break down these concepts and explain why they are central to modern wound care clinical practice.
The AMR challenge in wound care
As resistant pathogens become more prevalent, healthcare professionals are being called to rethink how they manage infections. Resistance can lead to delayed wound healing. 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 2050² and, in the U.S., more than 2.8 million antimicrobial-resistant infections occur each year3. 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 crisis4.
Why AMS is more than a buzzword
Antimicrobial stewardship (AMS) is a knowledge-based set of practices designed to preserve the effectiveness of antimicrobials while improving patient outcomes, ensuring the right drug, dose, duration, and route are used for each patient5. AMS aims to:
- Improve clinical outcomes
- Minimize adverse effects
- Reduce the emergence of resistance
- Lower healthcare costs
AMS encourages the use of non-antimicrobial interventions when possible6 and responsible prescribing and use of antibiotics7 to avoid compromising care for the patient. It does this by involving treatment plans for early intervention, appropriate wound care dressing selection, and ongoing reassessment of treatment plans.
AMR vs AMS: Two forces shaping the future of wound management
Treatment approaches to wound infection have relied on the use of antibiotics and antiseptics. However, the rise of resistant organisms has exposed the limitations of these methods. Bacteria-forming biofilms can be difficult to remove and often require more than antimicrobial agents alone⁸. This shift has prompted a move toward 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 is 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 work in collaboration with each other to address this potential increasing risk. 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 paper: Antimicrobial Resistance in Wound Care: Expert Panel Consensus Statements.
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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]
- https://www.cdc.gov/antimicrobial-resistance/data-research/facts-stats/index.html
- 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]
- 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]