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An infected wound is a localized defect or excavation of the skin or underlying soft tissue in which pathogenic organisms have invaded into viable tissue surrounding the wound. Infection of the wound triggers the body's immune response, causing inflammation and tissue damage, as well as slowing the healing process. Many infections will be self-contained and resolve on their own, such as a scratch or infected hair follicle. Other infections, if left untreated, can become more severe and require medical intervention.

The skin is the body's first line of defense, the surface of which is protected by a thin, acid film produced by the sebaceous glands called the acid mantle. This acid mantle is a dynamic barrier that regulates the skin's pH and maintains microorganisms called the normal flora that help prevent pathogens from entering the body. Pathogens will often displace some of the normal flora and colonize certain locations, but most of the time this does not lead to infection and does not stimulate an immune response. However, when the skin is broken or if the immune system becomes compromised, any of the microorganisms colonizing the skin or introduced to the wound can cause an infection. The microorganisms likely to infect a wound depend predominantly on what microorganisms are present on the skin, as well as the depth and location of the wound.

Symptoms of Infected Wounds

The clinical presentation of infected wounds includes fever, erythema, edema, induration, increased pain, and a change in drainage to a purulent nature. However, symptoms of infection in chronic wounds or debilitated patients may be more difficult to distinguish. In these cases, diagnosis may rely on non-specific symptoms such as loss of appetite, malaise, or decrease in glycemic control in diabetics.

Amputation Wound, Infected and Sloughy

Figure 1: Toe wound, amputation site infected and sloughy

Infected Toe Wound and Nail Bed

Figure 2: Infected toe wound and nail bed

Etiology

Most infected wounds are caused by bacterial colonization, originating either from the normal flora on the skin, or bacteria from other parts of the body or the outside environment. The most common infection-causing bacteria is Staphylococcus aureus and other types of staphylococci.

Risk Factors

  • Poor circulation
  • Diabetes
  • Obesity
  • Compromised or suppressed immune system
  • Decreased mobility or immobility
  • Malnutrition
  • Poor hygiene

Complications

Complications of infected wounds can vary in range from local to systemic. The most severe local complication of an infected wound is stalled wound healing, resulting in a non-healing wound. This often results in significant pain, discomfort and psychological detriment for the patient. Systemic complications can include cellulitis (bacterial infection of the dermal or subcutaneous layers of skin), osteomyelitis (bacterial infection of the bone or bone marrow) or septicemia (bacterial presence in the blood that can lead to a whole-body inflammatory state).

Diagnostic Studies

  • Bacterial culture
  • Gram stain
  • Antimicrobial susceptibility
  • Fungal culture
  • Blood culture

Treatments & Interventions for Infected Wounds

The following precautions can help minimize the risk of developing infected wounds in at-risk patients and to minimize complications in patients already exhibiting symptoms:

  • Prompt and proper wound cleansing to reduce bioburden
  • Maintaining proper nutrition and hydration

Approaches to treatment can be broken down by whether the infection is systemic or localized just to the wound area. Systemic treatment often will call for oral antibiotics, the specific type determined by microbiological investigation and local infection control protocols.

Localized infections can often be treated with topical antibiotics. Drainage or debridement may be necessary to remove slough and devitalized tissue, as these slow wound healing and can affect the efficiency of topical antibiotics. Antimicbrobial dressings, including those that use silver technology, may be used to help reduce bioburden. Antibiotics, whether topical or systemic, should only be used under the explicit direction of a physician.

Image Source: Medetec (www.medetec.co.uk). Used with permission.

References

American Association of Clinical Chemistry. Wound and Skin Infections. Lab Tests Online. http://labtestsonline.org/understanding/conditions/wound-infections. Updated August 26, 2018. Accessed September 11, 2018.

Collier M. Recognition and management of wound infections. World Wide Wounds. http://www.worldwidewounds.com/2004/january/Collier/Management-of-Wound-.... Updated January 2004. Accessed September 11, 2018.

HealthNews.org. Infected Wounds. Wound Care Centers. http://www.woundcarecenters.org/wound-types/infected-wounds.html. Accessed September 11, 2018.

McCulloch, JM, Kloth LC. Wound Healing: Evidence-based Management. 4th ed. Philadelphia, PA: F.A. Davis Company; 2010: 5, 109.

O'Dell ML. Skin and Wound Infections: An Overview. Am Fam Physician 1998;57(10):2424-2432. http://www.aafp.org/afp/1998/0515/p2424.html. Accessed September 11, 2018.

World Union of Wound Healing Societies (WUWHS). Principles of best practice: Wound infection in clinical practice. An international consensus update 2016. London: MEP Ltd, 2008. Available at: hhttp://www.woundinfection-institute.com/wp-content/uploads/2017/03/IWII-.... Accessed September 11, 2018.

For more information on infected wounds, a list of additional resources is offered below. Follow the links provided for specific resource contact information.

  • AAWC Pressure Ulcer Summit
  • Academy of Physicians in Wound Healing (APWH)
  • American Board of Wound Management (ABWM)
  • American College of Hyperbaric Medicine (ACHM)
  • American College of Wound Healing and Tissue Repair (ACWHTR)
  • American Physical Therapy Association (APTA)
  • American Professional Wound Care Association® (APWCA)
  • Association for the Advancement of Wound Care (AAWC)
  • Australian Wound Management Association (AWMA)
  • BioTherapeutics, Education & Research (BTER) Foundation
  • Canadian Association of Wound Care (CAWC)
  • European Tissue Repair Society (ETRS)
  • European Wound Management Association (EWMA)
  • Hope of Healing Foundation®
  • National Alliance of Wound Care and Ostomy® (NAWCO®)
  • Tissue Viability Society (TVS)
  • World Council of Enterostomal Therapists (WCET)
  • World Union of Wound Healing Societies (WUWHS)
  • Wound Care Education Institute (WCEI)
  • Wound Healing Foundation (WHF)
  • Wound Healing Society (WHS)
  • Wound, Ostomy, and Continence Nurses Society™ (WOCN®)

The following section includes additional WoundSource.com articles relating to infected wounds. To read the article(s) in full, follow the title link provided.

  • What Is Wound Bed Preparation?
  • Biofilm Management and Wound Bed Preparation
  • Wound Bed Preparation: Moisture Management
  • Wound Bed Preparation: Edge of Wound
  • Non-Cytotoxic Wound Cleansers: What Should I Use?
  • Silver Safety: Important Terms to Know
  • Terms to Know: Complex Wound Management
  • Infection Control and Wound Management: Important Terms to Know
  • Antimicrobial Stewardship in Wound Care: Program Basics
  • Managing Wound Infection: Opportunities in Antimicrobial Stewardship
  • The Future of Antimicrobial Stewardship in Wound Care
  • Wound Healing Pathophysiology and Infection
  • Biofilm Battles: Managing Chronic Infections
  • Factors Contributing to Complex Wounds
  • Complex Wounds: Common and Uncommon
  • Complex Wounds 101
  • Chronic Wounds and Biofilms: Frequently Asked Questions
  • Breaking the Biofilm Cycle: Strategies for Evaluating and Managing Wound Bioburden
  • Wound Biofilm Development and Virulence
  • Understanding the Wound Infection Continuum
  • The Skin Microbiome: Factors Related to Wound Chronicity
  • Terms to Know: Wound Biofilm Management
  • Controlling Bacterial Burden in Chronic Wounds
  • Wound Infection Management: Important Terms to Know
  • Multidrug-Resistant Organisms in Wound Management: State of the Science
  • Wound Chronicity and Infection: Strategies for Prevention and Management
  • Dressing for Prevention: Effective Wound Dressing Securement for Infection Prevention
  • Wound Bed Preparation and Biofilm Management
  • Biofilm Investigation: What's Under the Microscope?
  • What Are Biofilms?
  • Biofilm and Wound Healing
  • Prevention of Surgical Site Infections
  • Beauty and Biofilm: The Intersection of Science, Art, and Wound Care
  • Classification of Surgical Site Infections
  • 3 Non-Pharmacological Treatments for Wound Infection
  • Know the 8 Signs and Symptoms of Wound Infection
  • Wound Odor Management: Charcoal Wound Dressings
  • Identifying Infection in Wounds: Overview and Assessment
  • Factors in Wound Cleansing That May Impair Healing
  • Wound Healing: Reasons Wounds Will Not Heal
  • Case Review: Treatment of Full-Thickness Ulcers Due to Necrobiosis Lipoidica
  • How to Tell the Difference Between Necrotizing Fasciitis and Spider Bites
  • Why Not Use Maggots to Treat Wounds?
  • 4 Common Bacteria that Cause Infections in Wound Management
  • The Potential Use of Proteases in Wound Care Diagnostics
  • What You Can Do to Control Wound Care Costs
  • Washing Our Hands of Healthcare-Acquired Infections
  • Trading Places: Encouraging Wound Care Providers to Take the Patient's Perspective
  • Necrotizing Fasciitis: When A Harmless Bug Turns Deadly
  • Understanding Infection: An Overview of the Mechanisms of Viral, Fungal and Parasitic Infections
  • Can Amputation be Palliative?
  • Medical Nutrition Therapy for Chronic Wound Management: Assessing Outcomes
  • Infected Wound Therapies: Leeches, Maggots and Bees, Oh My!
  • The Accessibility of Biotherapy
  • Top Ten Tips for Negative Pressure Wound Therapy Dressing Applications
  • Wound Care on a Shoestring: Cost-Effective Options for the Treatment of Wounds
  • Wound Care in a Spin – Whirlpool Therapy

Products list:

The following section identifies specific products that are appropriate for the management or treatment of infected wounds, according to the companies who chose to list them here. This list is not all-inclusive; other products listed on WoundSource.com may also be indicated for this condition.

Dressings

Specialty Absorptives / Super Absorbents

  • Drawtex®
    Urgo Medical North America

Antimicrobial/Antibacterial Dressings

  • 3M™ Promogran Prisma™ Matrix Wound Dressing
    3M Health Care
  • Cutimed® Sorbact®
    BSN Medical Inc., an Essity Company
  • DermaBlue™+ Foam
    DermaRite Industries, LLC
  • Hydrofera Blue CLASSIC®
    Hydrofera
  • UrgoTul™ Ag
    Urgo Medical North America
  • Biatain® Ag Non-Adhesive Foam
    Coloplast Corp.
  • Biatain® Alginate Ag Dressing with Silver
    Coloplast Corp.
  • Biatain® Silicone Ag
    Coloplast Corp.
  • ColActive® Plus Ag Collagen Sheets and Powder
    HARTMANN USA, Inc.
  • Cutimed® Siltec® Sorbact®
    BSN Medical Inc., an Essity Company
  • Cutimed® Sorbact® Hydroactive B
    BSN Medical Inc., an Essity Company
  • Cutimed® Sorbion® Sorbact®
    BSN Medical Inc., an Essity Company
  • Hydrofera Blue READY®
    Hydrofera
  • SilvaKollagen® Gel
    DermaRite Industries, LLC
  • UrgoCell™ Ag
    Urgo Medical North America
Wound Cleansers

Wound Cleanser Products

  • Vashe® Wound Solution
    Urgo Medical North America
  • Dakin's Solution® Full Strength (0.5%)
    Century Pharmaceuticals, Inc.
Equipment

Biopsy/Punch Biopsy Kits

  • Soft Biopsy®
    Histologics, LLC

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Source URL (modified on 2018-09-11 13:52): https://www.woundsource.com/patientcondition/infected-wounds

Links
[1] http://www.woundsource.com/patientcondition/edema
[2] http://www.woundsource.com/patientcondition/wounds-heavy-or-purulent-drainage
[3] http://www.woundsource.com/patientcondition/chronic-wounds
[4] http://www.woundsource.com/product-category/wound-cleansers/wound-cleansers
[5] http://www.woundsource.com/product-category/nutritional-management/nutritional-supplements
[6] http://www.woundsource.com/product-category/debridement
[7] http://www.woundsource.com/product-category/dressings/antimicrobial-dressings
[8] http://www.medetec.co.uk
[9] http://labtestsonline.org/understanding/conditions/wound-infections
[10] http://www.worldwidewounds.com/2004/january/Collier/Management-of-Wound-infections.html
[11] http://www.woundcarecenters.org/wound-types/infected-wounds.html
[12] http://www.aafp.org/afp/1998/0515/p2424.html
[13] http://www.woundinfection-institute.com/wp-content/uploads/2017/03/IWII-Wound-infection-in-clinical-practice.pdf