Approach to infected skin ulcers.
OBJECTIVE
To review the diagnosis and management of infected chronic skin ulcers.


METHODS
Cochrane database, MEDLINE, and Google were searched for clinical practice guidelines (CPGs) for wound care. Most recommendations found in the CPGs had level II or III evidence. Expert and consensus opinion from the Canadian Chronic Wound Advisory Board and the International Wound Bed Preparation Advisory Board were also used.


RESULTS
Bacteria in skin ulcers act along a continuum from contamination through colonization and critical colonization to infection. Critical colonization is not always associated with overt signs of infection but can result in failure to heal, poor-quality granulation tissue, increased wound friability, and increased drainage. Good-quality swab samples should be an adjunct to clinical acumen, not a primary strategy for diagnosis. Iodine and silver-based dressings, topical antibiotics, and systemic antibiotics can be helpful.


CONCLUSIONS
Diagnosis of chronic wound infection is based on clinical signs and a holistic approach to patients. More research into assessment and treatment of skin ulcer infection is needed.
Frank
Christopher
C
St. mary's of the Lake Hospital, Kingston, ON. frankc@pccchealth.org
Bayoumi
Imaan
I
Westendorp
Claire
C
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D007455:Iodine / Q000627:therapeutic use; D008297:Male; D012834:Silver / Q000627:therapeutic use; D012883:Skin Ulcer / Q000175:diagnosis* / Q000628:therapy*; D014647:Varicose Ulcer / Q000175:diagnosis / Q000628:therapy; D014946:Wound Infection / Q000175:diagnosis* / Q000628:therapy*
D000900:Anti-Bacterial Agents; D012834:Silver; D007455:Iodine