ANTIMICROBIAL STEWARDSHIP DALAM PERAWATAN LUKA: INDIKASI, DURASI PENGGUNAAN, RISIKO JANGKA PANJANG, DAN IMPLEMENTASI PRAKTIK KEPERAWATAN BERBASIS EVIDENCE

Abstrak

Background: Antimicrobial resistance (AMR) continues to increase globally due to over-reliance on antimicrobials to treat and manage infections. Chronic wounds are particularly vulnerable to infection and harbor complex microbial communities, increasing the risk of secondary infections caused by antimicrobial-resistant bacteria. The inclusion of antimicrobial stewardship (AMS) into wound treatment and management has become crucial, but healthcare professionals face many challenges when trying to implement such approaches in their practice. Objective: The objective of this scoping review was to provide an overview of the scope and amount of the literature on AMS in wound care, study the characteristics of publications and topics, analyze the indications for antimicrobials in different settings of wound care, assess evidence on the duration of treatment and its long-term risks, provide evidence mapping on the implementation of nursing practice, and determine the gaps in the literature and directions of future research. Methods: The current study includes systematic searches in PubMed/MEDLINE, CINAHL, Cochrane Library, Scopus, and Web of Science databases in order to find relevant literature (2018-2026). The current scoping review used the PRISMA-ScR methodology and PCC framework. Data analysis involved narrative synthesis, thematic mapping, evidence gap mapping, and GRADE of evidence. Results: There were a total of 42 papers selected out of 3,003 articles screened for final inclusion into this synthesis. The selected papers had different study designs which included randomized controlled trials (28.6%), prospective cohorts (19.0%), retrospective cohorts (23.8%), cross-sectional studies (11.9%), quasi-experimental (9.5%) and mixed methods (7.1%). Thematic analysis yielded four main themes which were antimicrobial indications for wound care, appropriate therapy duration, risk factors including antimicrobial resistance, and implementation of evidence-based practice. The GRADE evaluation found that there was moderate certainty evidence on the use of ≤24-hour prophylactic antibiotics and AMS protocol adherence in the reduction of SSIs while there is high certainty evidence of MBD/DACC in reducing microbial load and not encouraging AMR. Conclusion: Although remarkable advancements have been made in terms of knowledge about indications and appropriate duration, there is still much to do in terms of implementing evidence-based nursing practice. The current review calls for the development of an Integrated Framework for AMS in Wound Care Nursing (IF-AMS-WCN), which would comprise four elements – assessment and diagnosis, intervention and treatment, monitoring and evaluation, and education and implementation. Future