Why Antimicrobial Stewardship?

Transcript

Hi, I'm Dr. Windy Cole. I'm the Director of Research at Kent State University College of Podiatric Medicine, and I'm here to talk to you about one of the posters I have at SAWC Spring.

I think it's important to understand that resistance is a real problem worldwide and we're really at fault. And not just DPMs, I think medical providers and patients. There's a wide variety of antibiotics that are prescribed that are unnecessary.

And I think we have to hold ourselves to a better standard. So instituting antimicrobial stewardship programs within our offices and our clinics, it is a big part in decreasing the antimicrobial resistance because these antibiotics we have are not as effective as they should be. And we just can't keep up with the change in the bacteria that is occurring because of over exposure to commonly using it.

So I think having a plan initially is a good start. So even being aware that it's a problem, I think it's the first step in really instituting any kind of microbial stewardship program, but it goes farther than that. I think we need to educate ourselves.

We need to educate our patients and we need to educate our staff about the importance of not just the knee-jerk reaction of prescribing every patient with a wound and antibiotic. We need to rely more on our clinical assessments and determine if there are clinical signs and symptoms of infection and then prescribe the appropriate antibiotic for the shortest duration of time when appropriate. If we have the access to advanced imaging tools, use those as well. They've been very helpful. So every wound has bacteria, whether they've been open for two weeks, two years.

It's almost 15 years, but not every single wound needs a antibiotic. Also using antimicrobial dressings, sort of as our first line of defense, when we're getting that critical colonization where there might be a very local infection, as opposed to just pulling the trigger and putting patients on a oral or systemic antibiotic would be appropriate as well. And really monitor our utilization of antibiotics.

I think you might be surprised to find what you actually prescribe and how often you actually prescribe antibiotics. There was a study that showed patients with diabetic foot ulcers get approximately four different antibiotic prescriptions throughout the treatment course of their wound. And I think we could probably do a lot better than that.