Monday, December 28, 2015

Infected Bed Sore

 General

Superficial Infections: Topical Antibiotic
  • Several topical antimicrobial agents reduce bacterial counts without damaging the wound, including silver sulfadiazine 1 percent cream, and other silver compounds
  • Some antiseptic agents, including povidone-iodine, peroxide, and chlorhexidine gluconate, are cytotoxic to human fibroblasts, can delay healing, and should not be used
  • Silver-containing dressings have been gaining popularity but their efficacy remains to be determined
  • Topical antibiotics are generally no longer recommended due to concerns about side effects and development of resistance
  • The routine use of medicated dressings in other circumstances is probably not indicated
  • A one to two week trial of topical antiseptics is reasonable for clean pressure ulcers that fail to heal after two to four weeks of optimal care .
  • If there is no improvement, further work-up should be pursued, including a soft tissue biopsy for culture and evaluation for underlying osteomyelitis
Deep Infections
  • Deep infection includes ulcers complicated by cellulitis, osteomyelitis, bacteremia, and/or sepsis, and requires systemic antimicrobial therapy
  • Management is based on the culture, site and type of infection
  • Because such infections usually are polymicrobial, therapeutic regimens should be directed against both gram-positive and gram-negative facultative organisms as well as anaerobic organisms
Systemic Antibiotic:
  • Systemic antibiotic therapy is required for patients with bacteraemia, sepsis, advancing cellulitis, or osteomyelitis.
  • Systemic antibiotics are not required for pressure ulcers that exhibit only signs of local infection. 
  • In patients due for surgery, it is necessary to review the microbiological status of the wound and provide systemic antimicrobial cover where appropriate


References:
  1. BMJ
  2. www.uptodate.com
  3. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Perth, Australia; 2014.
  4. Infected Pressure Ulcers in Elderly Individuals. Clin Infect Dis. (2002) 35 (11): 1390-1396

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