II. Pathophysiology
- Colonization of wound sites with normal skin flora is common
- Immunocompetent hosts typically heal minor wounds without secondary infection
III. Risk Factors
- Contaminated wound (manure, dirt, rust)
- Bite Injury
- Crush Injury
- High risk site (hand or foot)
- Bone exposed within Laceration
- Prolonged time to skin closure (see above)
- Underlying medical condition
IV. Signs
- Infection occurs within 48 hours in most cases
- However surgical wounds typically do not demonstrate infection in the first few days
- Localized infection
- Skin erythema
- Skin induration
- Local skin warmth
- Local wound pain
- Focal wound tenderness
- Purulent wound drainage
- Deeper or regional infection
- Lymphangitis
- Deep tissue abscess
- Fascial involvement
- Bone or joint involvement (Osteomyelitis, Septic Arthritis)
- Muscle or tendon involvement (e.g. Suppurative Tenosynovitis)
- Gangrene
- Systemic infection
- Fever
- Vomiting
- Tachycardia
- Hypotension
- Lethargy or other decreased mental status
- Metabolic Acidosis or Lactic Acidosis
- Leukocytosis
V. Management: General
- Wound cleaning with sterile saline
- Consider Wound Debridement (e.g. Sharp Debridement, Wet-to-Moist Dressings, Enzymatic Debridement)
- Elevate involved wound site
- Optimize comorbidities (e.g. Glucose management in Diabetes Mellitus)
VI. Management: Mild Wound Infections
- Criteria
- Two or more of the localized infection findings above AND
- Cellulitis <2 cm from wound edge AND
- Limited to superficial tissue or skin and without systemic symptoms
- Management
- Skin Abscess
- Impetigo and other focal, minor infections
- See Impetigo
- Topical Antibiotics
- Mupirocin 2% (Bactroban) or Retapamulin (Altabax)
- Metronidazole 0.75% gel if anaerobic organisms are suspected
- Systemic antibiotics may be indicated in some cases (e.g. Cephalexin, Dicloxacillin)
- Cellulitis
- See Cellulitis for antibiotic selection
VII. Management: Moderate Wound Infections
- Criteria
- Cellulitis extending >2 cm beyond wound edges OR
- Deeper or regional infection findings as above
- Management
- Cellulitis
- See Cellulitis for antibiotic selection
- Treat for at least 5 days
- Bite wounds
- See Dog Bite Infection (includes Cat Bite Infections)
- See Human Bite
- Burn Injury related infection
- See Burn Management
- Cellulitis
VIII. Management: Severe Wound Infections
- Criteria
- See systemic infection signs above
- Management
- Hospitalization in most cases
- Initiate parenteral antibiotics
- See Cellulitis for antibiotic selection
- Consider infectious disease Consultation
IX. Management: Refractory and Progressive Wound Infections
- Criteria
- Progressive infection with severe regional and systemic symptoms
- Management
- Consider Necrotizing Soft Tissue Infection (Necrotizing Fasciitis)
- Managed as severe Wound Infection above
- See Cellulitis for antibiotic selection
- Infectious disease Consultation
X. References
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | Infection occurring in the wound. |
Definition (NCI_CTCAE) | A disorder characterized by an infectious process involving the wound. |
Definition (CSP) | invasion of the site of trauma by pathogenic microorganisms. |
Definition (MSH) | Invasion of the site of trauma by pathogenic microorganisms. |
Concepts | Pathologic Function (T046) |
MSH | D014946 |
SnomedCT | 76844004 |
LNC | MTHU020838 |
English | Infection, Wound, Infections, Wound, Wound Infection, Wound Infections, INFECT WOUND, WOUND INFECT, wound infection, wound infection (diagnosis), Wound Infection [Disease/Finding], wound infected, infected wounds, septic wound, wound infections, Wound infection, Wound infected, Septic wound, Infected wound, Local infection of wound (disorder), Local infection of wound, infection; wound, wound; infection, Infected wound, NOS, Local infection of wound, NOS, infected wound, Infection;wound |
Italian | Infezione di ferita, Infezione da ferita |
French | Infection de plaie, Infection de blessure, Blessure infectée, Infection de la plaie, Plaie infectée, Infection d'une plaie |
Swedish | Sårinfektioner |
Japanese | ソウショウカンセン, 創傷感染, 感染-創傷, 創感染 |
Czech | rány - infekce, infekce ranné, Ranná infekce |
Finnish | Haavainfektio |
Russian | RANEVAIA INFEKTSIIA, РАНЕВАЯ ИНФЕКЦИЯ |
Croatian | RANA, INFEKCIJA |
Polish | Zakażenie rany |
Hungarian | sebfertőzés |
Norwegian | Sårinfeksjon |
Dutch | infectie; wond, wond; infectie, wondinfectie, Infectie, wond-, Wondinfectie |
Spanish | herida infectada, infección local de herida (trastorno), infección local de herida, Infección de herida, Infección de Heridas |
Portuguese | Infecção de ferida, Infecção dos Ferimentos |
German | Wundinfektion |