International guideline on antimicrobial stewardship and the role of microbial-binding dressings in wound care 2026: infection prevention, control, early intervention and treatment

BACKGROUND: Wound microbial burden and infection can delay wound healing, increase complications and rapidly progress to spreading or systemic infection, particularly in high-risk patients. Early diagnosis and appropriate treatment are essential for improved outcomes and reduced antimicrobial resistance (AMR). AMR is a growing concern in wound care due to reported inappropriate use of topical antiseptics, as well as systemic antibiotics. A recent survey found 41.8% of healthcare professionals used antimicrobial prophylactically, against recommendations, while 37.2% did not follow antimicrobial stewardship (AMS) guidance, indicating a potential gap in best-practice treatment. AIMS: The primary aim of this document was to provide evidence-based guidance on the role of microbial-binding dressings (MBDs) in managing microbial burden, preventing infection and reducing the need for antimicrobial intervention in both surgical incisions and hard-to-heal wounds. The secondary aim was to summarise key findings in four clinical pathways. METHODS: This guideline was developed according to AGREE II with a pragmatic literature review with GRADE assessments and a modified Delphi process for developing evidence-based statements. The literature search asked: 'In adults with a wound or surgical incision, do MBDs, compared with standard care, reduce surgical site infections, microbial burden, signs of infection, antibiotic use, antiseptic dressing use, time to healing or complication rates?'. For the statements, a 10-member expert panel scored agreement from 1 to 5, over three rounds (two remote and one in person), with acceptance at a mean score of ≥4.00 (SD ≤1.00). RESULTS: The literature review returned 12 studies on surgical incisions and 17 on hard-to-heal wounds, varying in evidence level and certainty. From 13 original statements, strong agreement was reached for 14; nine in round one, two in round two and three in round three (in-person meeting), with one statement split into two prior to agreement. The statements fit three themes: challenges of wound infection and AMR; benefits of MBDs for infection prevention and control (IPC); and early IPC in future AMS strategies. The guideline presents each statement with supporting evidence and detailed guidance for implementation in practice. This is followed by four easy-to-use AMS clinical pathways to support practical implementation, decision-making and consistency in care, currently under evaluation, with further validation studies expected. CONCLUSION: This guideline identifies and aims to meet a clear need for evidence-based best practice to enhance AMS in wound care. A paradigm shift towards infection prevention, early intervention and first-line treatment using MBDs should be considered an opportunity in everyday practice to minimise progression of infection, limit antimicrobial requirements and thus tackle the global threat of AMR.