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