Infection management

Infection management

Once the skin is broken the patient is at great risk of infection as there is a clear portal of entry for invading bacteria.1

Diagnosis Management

DIAGNOSIS

The local signs of infection include:1

  • Malodor
  • Grey/yellow tissue at base of ulcer
  • Purulent discharge


  • Undermining of wound edge
  • Visible tendon or bone
  • Sinuses within the ulcer
 Infection

In some instances these signs may not always manifest in an infected wound. Additional criteria have been identified and validated by an international multidisciplinary group of 54 experts using the Delphi approach. The following key criteria for the diabetic foot have been highlighted in the 2005 European Wound Management Association position document on infection:2

Criteria for wound infection 2

 

  • Cellulitis
  • Lymphangitis
  • Phlegmon
  • Purulent exudate
  • Pus/abscess

 

 

  • Crepitus in the joint
  • Erythema
  • Fluctuation
  • Increase in exudate volume
  • Induration
  • Localized pain in a normally asensate foot
  • Malodor
  • Probes to bone
  • Unexpected pain/tenderness

 

 

  • Blue-black discoloration and hemorrhage (halo)
  • Delayed/arrested wound healing despite offloading and debridement
  • Deterioration of the wound
  • Friable granulation tissue that bleeds easily
  • Local edema
  • Sinuses develop in an ulcer
  • Spreading necrosis/gangrene
  • Ulcer base changes from healthy pink to yellow or grey

 

 
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MANAGEMENT

According to the 2006 European Wound Management Association position document on “Management of wound infection” the principles of infection management are to:5

  • “Provide an environment to promote rapid healing
  • Minimize the use of antimicrobial agents that may adversely affect human cells
  • Use antimicrobial agents appropriately to reduce the selection of resistant strains
  • Restrict the use of systemic agents to when they are specifically indicated
  • Avoid topical sensitization or allergic reactions”

The choice of dressing to minimize the risk of infection is important. “Decisions need to be based on the ability of the dressing to:

  • Manage increased exudation
  • Remove necrotic tissue
  • Reduce malodor
  • Conform to the site and shape of the wound
  • Perform wound bed preparation functions
  • Satisfy patients’ expectations
  • And meet treatment goals” 5
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References [+]

  1. Edmonds ME, Foster AVM. Managing the diabetic foot, Oxford: Blackwell Science.
  2. Cutting KF, White RJ, Mahoney P, Harding KG. Clinical identification of wound infection: a Delphi approach. In: Moffatt CJ, K Cutting, B Gilchrist, F Gottrup, D Leaper, and P Vowden, eds. European Wound Management Association (EWMA). Position Document. Identifying criteria for wound infection. London: MEP Ltd; 2005:6-9.
  3. Edmonds M, Foster A. The use of antibiotics in the diabetic foot. Am J Surg. 2004;187(5A):25S-28S.
  4. Van der Mee-Marquet N, Blanchard M, Domelier AS, Quentin R. Virulence and antibiotic susceptibility of Staphylococcus aureus strains isolated from various origins. Pathol Biol (Paris). 2004;52(10):579-583.
  5. Vowden P, Cooper RA. An integrated approach to managing wound infection. In: Moffatt CJ, R Cooper, B Gilchrist, F Gottrup, D Leaper, R Pratt, and P Vowden, eds. European Wound Management Association (EWMA). Position Document. Management of wound infection. London: MEP Ltd; 2006:2-6.

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