References

Ackerley L From rogue restaurants to dirty homes: what can we learn? Perspectives in Public Health. 2009; 129:(2)67-8 https://doi.org/https://doi.org/10.1177/1757913908101645

Adams Waldorf KM, McAdams RM Influence of infection during pregnancy on fetal development. Reproduction. 2013; 146:(5)R151-62 https://doi.org/https://doi.org/10.1530/REP-13-0232

Allison DG The bacteria, 8th edn. In: Denyer S, Hodges N, Gorman SP, Gilmore B (eds). London: Blackwell Scientific Press;

Allison DG, Higginson P, Martin S Antibiotic resistance awareness: a public engagement approach for all pharmacists. Int J Pharm Pract. 2017; 25:(1)93-6 https://doi.org/https://doi.org/10.1111/ijpp.12287

Altimier L Neonatal Infection. Newborn and Infant Nursing Reviews. 2010; 10:(4) https://doi.org/https://doi.org/10.1053/j.nainr.2010.09.001

Arulkumaran N, Singer M Puerperal sepsis. Best Pract Res Clin Obstet Gynaecol. 2013; 27:(6)893-902 https://doi.org/https://doi.org/10.1016/j.bpobgyn.2013.07.004

European Antibiotic Awareness Day. 2015. http://mcrglobalhealth.com/2015/11/17/european-antibiotic-awareness-day/ (accessed 22 May 2017)

Baingana RK, Enyaru JK, Tjalsma H, Swinkels DW, Davidsson L The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women. Public Health Nutr. 2015; 18:(08)1423-35 https://doi.org/https://doi.org/10.1017/S1368980014001888

Buck ML, Amir LH, Cullinane M, Donath SM Nipple pain, damage, and vasospasm in the first 8 weeks postpartum. Breastfeed Med. 2014; 9:(2)56-62 https://doi.org/https://doi.org/10.1089/bfm.2013.0106

Buddeberg BS, Aveling W Puerperal sepsis in the 21st century: progress, new challenges and the situation worldwide. Postgrad Med J. 2015; 91:572-8 https://doi.org/https://doi.org/10.1136/postgradmedj-2015-133475

Chamberlain G British maternal mortality in the 19th and early 20th centuries. J R Soc Med. 2006; 99:(11)559-63 https://doi.org/https://doi.org/10.1258/jrsm.99.11.559

Cole A GPs feel pressurised to prescribe unnecessary antibiotics, survey finds. BMJ. 2014; 349 https://doi.org/https://doi.org/10.1136/bmj.g5238

Cordioli RL, Cordioli E, Negrini R, Silva E Sepsis and pregnancy: do we know how to treat this situation?. Rev Bras Ter Intensiva. 2013; 25:(4)334-44 https://doi.org/https://doi.org/10.5935/0103-507X.20130056

Department of Health. Catch-it-bin-it-kill-it campaign. 2013. https://www.gov.uk/government/news/catch-it-bin-it-kill-it-campaign-to-help-reduce-flu-infections (accessed 30 April 2017)

Ekiz C, Agaoglu L, Karakas Z, Gurel N, Yalcin I The effect of iron deficiency anemia on the function of the immune system. Hematol J. 2005; 5:(7)579-83 https://doi.org/https://doi.org/10.1038/sj.thj.6200574

Falagas ME, Karagiannis AKA, Nakouti T, Tansarli GS Compliance with once-daily versus twice or thrice-daily administration of antibiotic regimens: a meta-analysis of randomized controlled trials. PLoS One. 2015; 10:(1) https://doi.org/https://doi.org/10.1371/journal.pone.0116207

Feldman C, Anderson R Cigarette smoking and mechanisms of susceptibility to infections of the respiratory tract and other organ systems. J Infect. 2013; 67:(3)169-84 https://doi.org/https://doi.org/10.1016/j.jinf.2013.05.004

Fleming N Antimicrobial stewardship: The appropriate use of antibiotics. Practice Nursing. 2016; 27:(8)365-70 https://doi.org/https://doi.org/10.12968/pnur.2016.27.8.365

Green D, Labriola G, Smeaton L, Falconer M Prevention of neonatal whooping cough in England: the essential role of the midwife. British Journal of Midwifery. 2017; 25:(4)224-8 https://doi.org/https://doi.org/10.12968/bjom.2017.25.4.224

Hämeen-Anttila K, Nordeng H, Kokki E Multiple information sources and consequences of conflicting information about medicine use during pregnancy: a multinational Internet-based survey. J Med Internet Res. 2014; 16:(2) https://doi.org/https://doi.org/10.2196/jmir.2939

Hirji I, Andersson SW, Guo Z, Hammar N, Gomez-Caminero A Incidence of genital infection among patients with type 2 diabetes in the UK General Practice Research Database. J Diabetes Complications. 2012; 26:(6)501-5 https://doi.org/https://doi.org/10.1016/j.jdiacomp.2012.06.012

Saving Lives, Improving Mothers' Care: Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. In: Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2014

Saving Lives, Improving Mothers' Care: Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14. In: Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2016

Kourtis AP, Read JS, Jamieson DJ Pregnancy and Infection. N Engl J Med. 2014; 370:(23)2211-18 https://doi.org/https://doi.org/10.1056/NEJMra1213566

Kuperman AA, Koren O Antibiotic use during pregnancy: how bad is it?. BMC Med. 2016; 14:(1) https://doi.org/https://doi.org/10.1186/s12916-016-0636-0

Kwong JC, Maaten S, Upshur REG, Patrick DM, Marra F The effect of universal influenza immunization on antibiotic prescriptions: an ecological study. Clin Infect Dis. 2009; 49:(5)750-6 https://doi.org/https://doi.org/10.1086/605087

Lamb K, Sanders R Bladder care in the context of motherhood: ensuring holistic midwifery practice. British Journal of Midwifery. 2016; 24:(6)415-421 https://doi.org/https://doi.org/10.12968/bjom.2016.24.6.415

Loveday HP, Wilson JA, Pratt RJ epic3:National Evidence-Based Guidelines for Preventing Healthcare Associated Infections in NHS Hospitals in England”. Journal of Hospital Infection. 2014; 86:(S1)S1-S70 https://doi.org/http://doi.org/10.1016/S0195-6701(13)60012-2

McNulty CAM, Nichols T, French DP, Joshi P, Butler CC Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg. Br J Gen Pract. 2013; 63:(612)429-36 https://doi.org/https://doi.org/10.3399/bjgp13X669149

Mohamed-Ahmed O, Nair M, Acosta C, Kurinczuk JJ, Knight M Progression from severe sepsis in pregnancy to death: a UK population-based case-control analysis. BJOG: An International Journal of Obstetrics & Gynaecology. 2015; 122:(11)1506-15 https://doi.org/https://doi.org/10.1111/1471-0528.13551

NHS England. Improving outcomes for patients with sepsis. A cross-system action plan. 2015. https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-Action-Plan-23.12.15-v1.pdf (accessed 16 May 2017)

NHS, UNICEF, Start 4 Life. Guide to bottle feeding: how to prepare infant formula and sterilise feeding equipment to minimise the risks to your baby. 2015. https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf (accessed 18 April 2017)

National Institute for Health and Care Excellence. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use [NG15]. 2015. 2015. https://www.nice.org.uk/guidance/NG15/chapter/1-Recommendations#all-antimicrobials (accessed 30 April 2017)

Nobbs S, Crozier K Wound management in obese women following caesarean section. British Journal of Midwifery. 2011; 19:(3)150-6 https://doi.org/https://doi.org/10.12968/bjom.2011.19.3.150

Nordeng H, Ystrøm E, Einarson A Perception of risk regarding the use of medications and other exposures during pregnancy. Eur J Clin Pharmacol. 2010; 66:(2)207-14 https://doi.org/https://doi.org/10.1007/s00228-009-0744-2

The Code: Professional standards of practice and behaviour for nurses and midwives.London: Nursing and Midwifery Council; 2015

Living with a superbug: My next infection could be my last. 2017. https://www.newscientist.com/article/2126778-living-with-a-superbug-my-next-infection-could-be-my-last/ (accessed 16 May 2017)

Rapid diagnostics: stopping unnecessary use of antibiotics. 2015. https://amr-review.org/sites/default/files/Rapid%20Diagnostics%20-%20Stopping%20Unnecessary%20use%20of%20Antibiotics.pdf (accessed 22 May 2017)

Ponnampalan S, Khalil A, O'Brien P Swine flu and pregnant women: Advice, prevention and management. British Journal of Midwifery. 2011; 19:(2)76-80

Public Health England. Health matters: antimicrobial resistance. 2015. https://www.gov.uk/government/publications/health-matters-antimicrobial-resistance/health-matters-antimicrobial-resistance (accessed 22 May 2017)

Pustotina O Management of mastitis and breast engorgement in breastfeeding women. J Matern Fetal Neonatal Med. 2016; 29:(19)3121-5 https://doi.org/https://doi.org/10.3109/14767058.2015.1114092

Robinson DP, Klein SL Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Horm Behav. 2012; 62:(3)263-71 https://doi.org/https://doi.org/10.1016/j.yhbeh.2012.02.023

Royal College of Obstetricians and Gynaecologists. Patterns of maternity care in English NHS trusts 2013/14. 2016. https://www.rcog.org.uk/globalassets/documents/guidelines/research--audit/maternity-indicators-2013-14_report2.pdf (accessed 18 May 2017)

Royal College of Nursing. Essential practice for infection prevention and control: Guidance for nursing staff. 2012. https://my.rcn.org.uk/__data/assets/pdf_file/0008/427832/004166.pdf (accessed 27 May 2017)

Say L, Chou D, Gemmill A Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2:(6)e323-33 https://doi.org/https://doi.org/10.1016/S2214-109X(14)70227-X

Schneeberger C, Geerlings SE, Middleton P, Crowther CA Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database Syst Rev. 2015; (7) https://doi.org/https://doi.org/10.1002/14651858.CD009279.pub3

Shallcross LJ, Davis SC Antibiotic overuse: a key driver of antimicrobial resistance. Br J Gen Pract. 2014; 64:(629)604-5 https://doi.org/https://doi.org/10.3399/bjgp14X682561

Too much of a good thing. 2015. http://s.telegraph.co.uk/graphics/projects/antibiotic-resistance/#top (accessed 22 May 2017)

Sharma M, Solanki A Prevalence of Candida infection in pregnant women with and without diabetes. Int J Curr Microbiol Appl Sci. 2014; 3:605-10

Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A Physiological changes in pregnancy. Cardiovasc J Afr. 2016; 27:(2)89-94 https://doi.org/https://doi.org/10.5830/CVJA-2016-021

Starlander G, Lytsy B, Melhus A Lack of hygiene routines among patients and family members at patient hotels-A possible route for transmitting puerperal fever. Scand J Infect Dis. 2010; 42:(6-7)554-6 https://doi.org/https://doi.org/10.3109/00365541003699656

The Path of Least Resistance.London: Department of Health; 1998

Tambe P, Sammons HM, Choonara I Why do young children die in the UK? A comparison with Sweden. Arch Dis Child. 2015; 100:(10)928-31 https://doi.org/https://doi.org/10.1136/archdischild-2014-308059

Tipton AM, Cohen SA, Chelmow D Wound infection in the obese pregnant woman. Semin Perinatol. 2011; 35:(6)345-9 https://doi.org/https://doi.org/10.1053/j.semperi.2011.05.020

The Breastfeeding Network. Expressing and Storing breastmilk. 2014. https://www.breastfeedingnetwork.org.uk/breastfeeding-help/expressing-storing/ (accessed 27 May 2017)

Twigg MJ, Lupattelli A, Nordeng H Women's beliefs about medication use during their pregnancy: a UK perspective. Int J Clin Pharm. 2016; 38:(4)968-76 https://doi.org/https://doi.org/10.1007/s11096-016-0322-5

Uchil RR, Kohli GS, Katekhaye VM, Swami OC Strategies to Combat Antimicrobial Resistance. J Clin Diagn Res. 2014; 8:(7)ME01-4 https://doi.org/https://doi.org/10.7860/JCDR/2014/8925.4529

Wiegers T Adjusting to motherhood. Journal of Neonatal Nursing. 2006; 12:(5)163-171 https://doi.org/http://dx.doi.org/10.1016/j.jnn.2006.07.003

World Health Organization. Exclusive breastfeeding. 2017. http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/ (accessed 16 May 2017)

World Health Organization. World Health Statistics 2014: Large gains in life expectancy. 2014. http://www.who.int/mediacentre/news/releases/2014/world-health-statistics-2014/en/ (accessed 22 May 2017)

Yealy DM, Huang DT, Delaney A Recognizing and managing sepsis: what needs to be done?. BMC Med. 2015; 13 https://doi.org/https://doi.org/10.1186/s12916-015-0335-2

Standard Infection Control Precautions (SICPs) Literature Review: Hand Hygiene Hand washing in the hospital setting. 2016. http://www.nipcm.hps.scot.nhs.uk/documents/sicp-hand-hygiene-hand-washing-in-the-hospital-setting/ (accessed 16 May 2017)

Antimicrobial resistance, antibiotic stewardship, and the midwife's role

02 November 2017
9 min read
Volume 25 · Issue 11

Abstract

Antimicrobial resistance is one of the greatest challenges to health care. With a reduced number of effective antibiotics, treatable conditions, such as ear, tooth and urine infections, may therefore become life-threatening. In order to minimise antimicrobial resistance, midwives should use clinical strategies that facilitate antibiotic stewardship, such as promoting healthy lifestyles, infection control and compliance with prescribed antibiotic treatment, and should endeavour to share knowledge and expertise with members of the wider multidisciplinary team, such as pharmacists. In addition, midwifery curricula should ensure that midwives have a knowledge of the dynamics of antimicrobial resistance and principles of antibiotic stewardship so that health professionals may share their expertise in order to combat this significant challenge, which poses the threat of a post-antibiotic era.

Antimicrobial—or antibiotic—resistance poses an urgent problem for midwives and public health authorities on a global level. Antimicrobial resistance is defined by the National Institute for Health and Care Excellence (NICE) as:

‘The loss of effectiveness of any anti-infective medicine, including antiviral, antifungal, antibacterial and antiparasitic medicines.’

Society now faces the prospect of a future without antibiotics, since it is estimated that 70% of the world's bacteria have developed resistance to antibiotics (Public Health England, 2015). There are various factors that are believed to have caused this situation, which include (Public Health England, 2015):

Before the discovery of penicillin in 1928, an average of 1 in 10 individuals died from meningitis, pneumonia and skin infections, compared with today's rate of 1 in 100 (Ashiru-Oredope, 2015). Similarly, deaths from childbirth-related sepsis were 3 in 100 before antibiotics and are now less than 3 in 100 000 (Ashiru-Oredope, 2015). Indeed, the World Health Organization (WHO) have estimated that antibiotics have extended human lifespan by approximately 20 years (WHO, 2014). Nevertheless, the emergence of multiple resistant organisms, associated with misuse of antibiotics, has contributed to a post-antibiotic era, where the protection that antibiotics have conferred for so many years is no longer reliable (Shute, 2015).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month