Approach to chronic wound infections

D. Leaper, O. Assadian, Charles E. Edmiston

Research output: Contribution to journalReview article

41 Citations (Scopus)

Abstract

Summary 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. What's already known about this topic? Infection is the most likely cause of stalled healing in chronic wounds. Infection in chronic wounds is a clinical decision-making process; a diagnostic would be useful for practitioners. Presence of biofilm cannot be detected clinically and a diagnostic is needed. What does this study add? Presence of biofilm is the likely cause of persistent infection and requires maintenance debridement at dressing changes, as well as topical antiseptic intervention. Use of antibiotics to treat infections in chronic wounds requires strict antibiotic stewardship.

Original languageEnglish
Pages (from-to)351-358
Number of pages8
JournalBritish Journal of Dermatology
Volume173
Issue number2
DOIs
Publication statusPublished - 1 Aug 2015

Fingerprint

Wound Infection
Biofilms
Local Anti-Infective Agents
Infection
Wounds and Injuries
Anti-Bacterial Agents
Debridement
Bandages
Maintenance
Multiple Organ Failure
Microbial Drug Resistance
Antigen-Antibody Complex
Research
Free Radicals
Sepsis
Nitric Oxide
Randomized Controlled Trials
Cytokines
Inflammation

Cite this

Leaper, D., Assadian, O., & Edmiston, C. E. (2015). Approach to chronic wound infections. British Journal of Dermatology, 173(2), 351-358. https://doi.org/10.1111/bjd.13677
Leaper, D. ; Assadian, O. ; Edmiston, Charles E. / Approach to chronic wound infections. In: British Journal of Dermatology. 2015 ; Vol. 173, No. 2. pp. 351-358.
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Leaper, D, Assadian, O & Edmiston, CE 2015, 'Approach to chronic wound infections', British Journal of Dermatology, vol. 173, no. 2, pp. 351-358. https://doi.org/10.1111/bjd.13677

Approach to chronic wound infections. / Leaper, D.; Assadian, O.; Edmiston, Charles E.

In: British Journal of Dermatology, Vol. 173, No. 2, 01.08.2015, p. 351-358.

Research output: Contribution to journalReview article

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Leaper D, Assadian O, Edmiston CE. Approach to chronic wound infections. British Journal of Dermatology. 2015 Aug 1;173(2):351-358. https://doi.org/10.1111/bjd.13677