Chronic Wound and Infection
A wound is defined as a disruption of tissue integrity caused by physical, chemical, thermal, radiation, or surgical factors, or occurring spontaneously.
Acute wound:
Wounds that are traumatic or surgical in origin, generally respond appropriately to the expected healing process, and are clean.
Chronic wound:
Wounds that heal slowly or with difficulty, or do not heal at all. (Wounds that do not heal within 6-8 weeks or show no signs of healing within 4 weeks)
- There is usually an underlying cause that delays healing (vascular problems, diabetes, infection, radiation damage, pressure, malnutrition, etc.).
- Chronic wounds can occur for various reasons and are classified according to these causes.
- Pressure ulcer (commonly known as bedsores, which can occur on the hips or heels or both areas)
- Chronic Wound
- Arterial insufficiency wound
- Venous ulcer
- Radiation damage
- Post-operative wounds
There are three basic stages of healing in acute wounds: the inflammation phase, the proliferation phase, and the maturation phase. In chronic wounds, the development of these phases is problematic, and wound healing cannot complete these phases.
Open skin wounds lack many defense mechanisms and are almost always colonized by microorganisms. Non-healing wounds are characterized by prolonged inflammation, inadequate re-epithelialization, and impaired matrix formation. Bacteria are present on a wound in four ways.
1. Contamination
The presence of bacteria that do not multiply in the wound and do not cause a host reaction. Occurs in both acute and chronic wounds.
2. Colonization
Bacteria multiply within the wound, but do not cause damage to the host. Occurs in chronic wounds.
3. Critical Colonization
Microorganisms are present and multiplying in the wound, triggering a local immune response rather than a systemic one. This is a dangerous phase in chronic wounds and may subsequently delay the wound healing process. This condition often has a slippery slope and can rapidly progress to infection in chronic wounds.
4. Infection
There are bacteria multiplying in the wound and surrounding soft tissue, and a host response that leads to a decrease or cessation of wound healing.
Although it is generally accepted that the microbiological examination of the sample taken should be considered when selecting antibiotics for chronic wound infections, this choice is often made empirically. This approach is based on predicting which microorganisms may be involved, depending on the severity of the infection. Factors such as the severity of the infection, previous antibiotic use, hospitalization, or healthcare-associated factors (e.g., dialysis patients) determine the types of microorganisms that may be involved in patients. In patients with chronic wound infections, the need for empirical treatment must be considered before starting antibiotics, and in patients without a septic picture, the microbiological results of the wound sample should guide the choice of antibiotics. When taking a sample from the wound site, taking a deep tissue sample rather than a swab from the wound surface is the most appropriate approach. Swab samples taken from the wound surface often contain colonizing bacteria as well as the causative agent of the infection, leading to the continuation of treatment with broader-spectrum antibiotics. Therefore, necrotic tissue on the wound surface should first be removed, and a sample should be taken from the underlying healthy tissue. In septic patients, antibiotic treatment should be initiated immediately after sample collection, taking the patient's condition into account, and treatment should be reevaluated based on the culture results.