Wound infection is a major burden for patients, delaying healing and impacting quality of life,¹⁻⁵ making it a major concern for many healthcare professionals (HCPs).⁶ Progression can lead to serious complications, including spreading infection, systemic involvement and even amputation or death,¹ ⁷⁻⁹ requiring significant resources to treat.¹⁰⁻¹²

These challenges are amplified in infections caused by microbes that are resistant to antimicrobial treatment.¹³ ¹⁴ Infections with antimicrobial resistance (AMR) are more difficult to treat and increase risk of death, being associated with over 4.7 million deaths from 1990 to 2021, including an 80% increase in deaths in patients older than 70 years.¹⁴

AMR, the process by which microbes (bacteria, fungi, parasites, viruses) evolve mechanisms to reduce the effectiveness of antimicrobials, develops in response to selective pressure from antimicrobial challenge and natural selection, particularly if antimicrobials are used inappropriately, increasing antimicrobial treatment failure and making infections more difficult to treat.¹⁵ The global burden of AMR‑related infection is predicted to rise by 2050,¹⁴ placing it among the World Health Organization’s top 10 threats to global health.¹⁶

These trends are mirrored in wound care, where both hard‑to‑heal¹⁷⁻²⁰ and surgical wounds²¹⁻²³ increasingly demonstrate complications driven by antimicrobial‑resistant organisms. This burden is further exacerbated in clinical practice by the inappropriate use of antimicrobials, including topical antiseptics and systemic antibiotics, particularly when they are applied in the absence of infection.²⁴⁻²⁸ Collectively, these challenges underscore the need for greater awareness of AMR‑related issues in wound management.

Wound care has a widely identified need for greater antimicrobial stewardship (AMS).²⁹⁻³³ AMS can be defined as systematic, healthcare‑wide approach to promoting the judicious, responsible use of antimicrobials as part of infection prevention and control (IPC) strategies,³⁴ to preserve their future effectiveness.²⁹ ³⁵ ³⁶ However, in a recent observational study only 33% of surgeons complied with AMS guidelines,³⁷ and a recent survey found 37.2% of HCPs did not follow AMS guidance in everyday practice.²⁸ These findings pave the way for new guidance on AMS in wound care.