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Infected Wounds

An infected wound is a localized defect or excavation of the skin or underlying soft tissue in which pathogenic organisms have invaded into tissue within and surrounding the wound. Understanding the risk factors, clinical manifestations, etiological agents, treatment modalities, and potential complications is crucial for effective management. 

Risk Factors

Several factors predispose individuals to wound infections:

Diabetes mellitus. Patients with diabetes, particularly those with peripheral neuropathy, are at heightened risk due to diminished sensation and impaired healing.1,2 

Peripheral arterial disease (PAD). Reduced blood flow in PAD impairs wound healing and increases infection susceptibility.3 

Immunosuppression. Conditions such as HIV/AIDS, malignancies, or use of immunosuppressive therapies compromise the immune response, facilitating potential infections.4 

Chronic edema. Persistent swelling, as seen in conditions such as lymphedema, can impair skin integrity and defense mechanisms.1

Trauma or surgery. Breaks in the skin from injuries or surgical procedures provide entry points for pathogens.4

Clinical Manifestations of Wound Infections

Local symptoms. Erythema, edema, warmth, pain, and purulent discharge are hallmarks of infection that should raise one’s clinical suspicions.1

Systemic symptoms. Fever, chills, lymphadenopathy, and malaise suggest systemic involvement and could trigger concern for a deeper or more widespread infection.1

Symptoms of severe infection. Rapidly spreading erythema, necrosis, crepitus (suggesting gas-forming organisms), and systemic inflammatory response syndrome (SIRS) suggest urgent or emergent infection warranting swift intervention.1

Classification Systems

Several entities have developed classification systems for the severity of infected wounds. These include the International Working Group on the Diabetic Foot/Infectious Diseases Society of America, and the Centers for Disease Control and Prevention.1,5

Etiology

Wound infections are commonly polymicrobial, with both aerobic and anaerobic organisms contributing to pathogenesis.

Common Gram-positive pathogens include Staphylococcus aureus (including methicillin-resistant S aureus [MRSA]) and Streptococcus species.1,6

Pertinent Gram-negative pathogens include Pseudomonas aeruginosa, Proteus species, Escherichia coli, and Klebsiella pneumoniae.1,6

Anaerobic bacteria of note include Bacteroides and Clostridium species, particularly in necrotizing infections.1,6

Treatment

Local wound care. This includes, but is not limited to, debridement of necrotic or devitalized tissue to reduce bacterial burden and proper wound dressing techniques to maintain an optimal healing environment.1

Antibiotic therapy. One may initial choose empiric antibiotics to cover a broad spectrum of organisms, usually including Gram-positive cocci, considering MRSA risk, and adding coverage for gram-negative rods in moderate-to-severe infections.1 Definitive antibiotic therapy should be tailored based on culture and sensitivity results. The duration of therapy is often 1–2 weeks for soft tissue infections and up to 6 weeks for osteomyelitis.

Surgical intervention. This is indicated for instances including deep abscesses, necrotizing infections, and osteomyelitis with extensive bone involvement.1 

Adjunctive therapies. Additional advanced therapy choices, tailored to the needs of each case, could include hyperbaric oxygen therapy, negative pressure wound therapy, repeat surgical debridement and/or lavage, antibiotic bead placement, and other therapies. 

Complications

If not promptly and adequately addressed, infected wounds can lead to severe complications.1 These include sepsis, osteomyelitis, necrotizing fasciitis, and gangrene. 

Conclusion

Infected wounds require a comprehensive approach, integrating meticulous wound care, appropriate antimicrobial therapy, and, when necessary, surgical intervention. Early identification and management are paramount to prevent progression to severe complications. Clinicians should remain vigilant for risk factors and clinical signs to ensure timely and effective treatment. 
 

References
1.        Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev. 2024;40(3):e3687. doi:10.1002/dmrr.3687
2.    Bodman MA, Dreyer MA, Varacallo MA. Diabetic Peripheral Neuropathy. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442009/
3.        Murphy-Lavoie HM, Ramsey A, Nguyen M, et al. Diabetic Foot Infections. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441914/
4.        Zabaglo M, Leslie SW, Sharman T. Postoperative Wound Infections. [Updated 2024 Mar 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560533/\
5.        Centers for Disease Control and Prevention. National Healthcare Safety Network. Surgical Site Infection Event (SSI). Available at https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Published January 2023. Accessed March 20, 2025. 
6.        Puca V, Marulli RZ, Grande R, et al. Microbial Species Isolated from Infected Wounds and Antimicrobial Resistance Analysis: Data Emerging from a Three-Years Retrospective Study. Antibiotics (Basel). 2021;10(10):1162. Published 2021 Sep 24. doi:10.3390/antibiotics10101162