Antimicrobial resistance: The Glasgow OMF model

Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. e-mail: bdj@bda.org. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space. Readers may now comment on letters via the BDJ website (www.bdj.co.uk). A 'Readers' Comments' section appears at the end of the full text of each letter online. Sir, in response to the letter by Singh1 highlighting the challenges of the infection workload in oralmaxillofacial (OMF) surgery and access to microbiology advice from clinical oral microbiologists (COMs) we outline how the service is utilised in Glasgow. In NHS Glasgow and Clyde Region there is one clinically active oral microbiologist who works with the maxillofacial services at the Queen Elizabeth University Hospital (QEUH) and Glasgow Dental Hospital. The regional OMF unit runs a trauma and surgical oncology service that includes management of severe odontogenic infections. There is a weekly ward round (Tuesdays 08:00) with the OMF team where cases, microbiology specimens, results and antimicrobial treatment plans are discussed and reviewed. Microbiology reports being reviewed the previous day from the laboratory e-reporting system by the COM. This process provides a vital antimicrobial stewardship link with improvements in clinical outcomes. An example of this is the move towards more prolonged antimicrobial treatment of complex ORN/MRONJ cases in collaboration between OMF with the outpatient antimicrobial treatment (OPAT) unit. The key to success of these interactions is teamwork as the COM is embedded in the medical microbiology services who combine to support a 24-hour and 365-days-a-year service to OMF. Howerver, this system does have its challenges as the COM is a clinical academic under the usual pressures for publications and grant funding. Furthermore, the diagnostic facilities are no longer located in the dental hospital which entails travelling to different sites. In terms of undergraduate awareness of COM clinical training and scope of practice, ACOM and others have been lobbying for an increase in training numbers to the COM specialty for a number of years and have recommended to the Council of Dental School Deans that every school must have access to this level of academic and clinical support. In response to the scenario described in the letter the answer is the one that provides the best clinical outcome for the patient, ie multi-disciplinary teamwork that includes access to a COM is the way forward. Perhaps pressure from the commissioning guide for dental specialties2 and activity by the postgraduate deaneries to create COM training posts will help improve patient outcomes from infection by improving access to expert advice?