Chronic Wound Infections Don't Need Antibiotics

The Canadian government has recently approved funding for a large study of nitric oxide gas to see if the results can be duplicated in other nonhealing wounds.

How to Identify Wound Types

Contamination

▸ Example: Fall from a bike, abraded skin.

▸ Bacteria: “Just passing through.”

▸ Signs and symptoms: None.

▸ Healing: Not compromised.

▸ Testing: None necessary.

▸ Treatment: Cleansing with normal saline.

Simple Colonization

▸ Example: Wound of a few days' duration.

▸ Bacteria: Living in the wound, but planktonic and disorganized.

▸ Signs and symptoms: None of note.

▸ Healing: Not compromised.

▸ Testing: None required.

▸ Treatment: Cleansing with normal saline.

Complicated Colonization (Biofilm)

▸ Example: Chronic wound.

▸ Bacteria: Significant in numbers and virulence. Well organized, often as a “biofilm.”

▸ Signs and symptoms: New onset of wound pain and wound-bed deterioration (granulation tissue loss, friability of granulation tissue).

▸ Healing: Compromised.

▸ Testing: None required.

▸ Treatment: Aggressive debridement, possibly with adjunctive antimicrobial measures (such as manuka honey or starch iodine).

Clinical Infection (Rare)

▸ Example: Markedly worsening chronic wound.

▸ Bacteria: Very significant in numbers and virulence.

▸ Signs and symptoms: Significant in numbers and virulence. Well organized, often as “biofilm.” There is evidence of a host inflammatory response (cellulitis) and possible systemic toxicity (fever and malaise).

▸ Healing: Compromised.

▸ Testing: Wound biopsy of base preferable to culture.

▸ Treatment: Systemic antibiotics.

Source: Dr. Kunimoto