Introduction
- All chronic wounds are colonized with bacteria
- Different bacteria thrives in different environments
- Some bacteria needs oxygen
- Some bacteria can live without
- Some bacteria die in oxygen
- All wounds have niches with different micro-environments
- On average, a chronic wound host 6 different bacterial strains
Venous Leg Ulcer Bacteriology
Gødsbøl et al., Copenhagen Wound Healing Center:
- Staphylococcus aureus (93.5%)
- Enterococcus faecalis (71.7%)
- Pseudomanas aeruginosa (52.2%)
- Coagulase-negative staphylococci (45.7%)
- Proteus species (41.3%)
- Anaerobic bacteria (39.1%)
Uneven Bacterial Distribution
Surface
Depth
Infection
- Infection is not equal to presence of bacteria
- Signs of infection is:
- {“Bacterial Harmfulness” X “Host Response”}
TILI Score
Therapeutical Index for Local Infection: a tool to help identification of infection.
Four of five non-direct identification criteria
or
one of direct identification criteria
indicate local infection
(but presence of wound pathogens)
Wound pathogens
Almost all bacteria may be pathogens
Identification of a pathogen without clinical signs of infection
Swab
Why swab?
- To identify the bacteria responsible for the infection
- To identify the resistance pattern
- To guide antibiotic treatment
When swab?
- Before start of an antibiotic treatment
How to swab?
- Debride the wound surface
- Rinse
- Pat dry with clean towel
- Swab using a spiral technique (Essen rotary) or similar, to cover the surface
- Do not swab the edges or periwound skin
Treatment
- Antibiotics according to the local guidelines
- Short duration (one to two weeks)
- Regular assessment and evaluation of response
EWMA one-pagers
EWMA one-pager: Antimicrobial Stewardship in Wound Care
