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40 y/o F, no PMHx. Scalding water burn x4 wks ago. PCP placed on Amoxicillin and mupirocin. Was improving, then started blistering and worsening redness at 3 weeks. Started on Cipro, SSD with foam dressing. Continues to worsen in redness and now with green drainage. She had allergic reaction to Amoixicillin and Cipro with hives. Initial swab culture (2 weeks ago) was negative. Tried less irritating dressing with hydrogel and foam given sensitive skin hx. Continues to worsen.

Considering superimposed fungal infection? Other suggestions for tx?
Dec 23, 2020 by Eilon Scheiner, COO- Consultant
3 replies
Eugene Worth
MD, M.Ed., FABA, ABPM/UHM
Hi, Eilon:

Since no one else has answered, let me take a stab at it. I’m going to get the highlights, I’m sure that others will chime in with more scientific details.

The dressing picture told the story for me. It doesn’t appear to be a fungal infection, that’s Pseudomonas drainage on your dressing. I prefer to hit this topically instead of a oral/systemic antibiotic. So, here’s what I would do ...
1) Soak the burn area topically with 0.25 - 0.5% acetic acid solution. 10 minutes topical soak when changing dressings would be fine. Then light rinse with normal saline. Pat dry.
2) Looks like the skin is closed. Yes, blistered, but essentially closed. Therefore, you don’t need a topical antibiotic goo, gel, or cream.
3) Sometimes with Pseudomonal infections, I will use 2 - 3 drops of ophthalmic gentamicin solution and spread it out with a cotton swab over the extent of the wound.
4) My dressing of choice would be Tegaderm foam or some sort of foam dressing. Change daily to start ... can be every other day to every third day when the wound starts to respond.
5) This is a leg (looks like), so a double layer of Tubigrips wouldn’t hurt to cover the dressing.

Those are my ‘off the cuff’ thoughts about this. I’m pretty sure that your wound will turn around in a week or so.

Gene
Dec 23, 2020
Eugene Worth
MD, M.Ed., FABA, ABPM/UHM
One more thought. I’m going to say this with my outside voice ... I hate hydrogel! I would repeat, but just read that twice ... There are a few places where it is effective, but this isn’t one of them. Hydrogel will trap this wound and make the drainage worse, in my opinion ... so, no to hydrogel from me. Just a very simple foam dressing will work fine. Keep it simple!!
Dec 23, 2020
Eilon Scheiner
COO- Consultant
Thank you so much for the detailed response. Agreed, re: pseudomonas. Great rec on the acetic acid dressings. Will start and hopefully see some progression. Thanks again!
Dec 23, 2020
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