Leaper D, Assadian O, Edmiston CE, et al.
The British journal of dermatology. Date of publication 2015 Aug 1;volume 173(2):351-8.
1. Br J Dermatol. 2015 Aug;173(2):351-8. doi: 10.1111/bjd.13677. Epub 2015 Mar 15.
Approach to chronic wound infections.
Leaper D(1), Assadian O(2), Edmiston CE(3).
Author information:
(1)Institute of Skin Integrity and Infection Prevention, University of
Huddersfield, Huddersfield, U.K.
(2)Clinical Microbiology, Infection Control, Infectious Diseases and Tropical
Medicine, Department of Hospital Hygiene and Infection Control, Medical
University of Vienna, Vienna, Austria.
(3)Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, U.S.A.
Infection is the likeliest single cause of delayed healing in healing of chronic
open wounds by secondary intention. If neglected it can progress from
contamination to colonization and local infection through to systemic infection,
sepsis and multiple organ dysfunction syndrome, and it can be life-threatening.
Infection in chronic wounds is not as easy to define as in acute wounds, and is
complicated by the presence of biofilms. There is, as yet, no diagnostic for
biofilm presence, but it contributes to excessive inflammation - through
excessive and prolonged stimulation of nitric oxide, inflammatory cytokines and
free radicals - and activation of immune complexes and complement, leading to a
delay in healing. Control of biofilm is a key part of chronic wound management.
Maintenance debridement and use of topical antimicrobials (antiseptics) are more
effective than antibiotics, which should be reserved for treating spreading local
and systemic infection. The continuing rise of antimicrobial resistance to
antibiotics should lead us to reserve their use for these indications, as no new
effective antibiotics are in the research pipeline. Antiseptics are effective
through many mechanisms of action, unlike antibiotics, which makes the
development of resistance to them unlikely. There is little evidence to support
the theoretical risk that antiseptics select resistant pathogens. However, the
use of antiseptic dressings for preventing and managing biofilm and infection
progression needs further research involving well-designed, randomized controlled
trials.
© 2015 British Association of Dermatologists.
DOI: 10.1111/bjd.13677
PMID: 25772951 [Indexed for MEDLINE]
