Wound colonization and infection: the role of topical antimicrobials

Infection and bacterial colonization are important factors in compromised wound healing, particularly in chronic wounds. The current "best practice" for controlling these factors is still unclear. Systemic antibiotics are generally accepted as being the preferred choice for treating infection, provided that ischaemia does not interfere. However, their widespread systemic and topical use is leading to the emergence of resistant bacterial strains such as methicillin-resistant Staphylococcus aureus. Colonization of wounds presents a double problem: possible delayed healing if out of balance with the immune system; and as a source for cross-infection. Managing colonization is not yet defined in best practice. The judicious use of dressings, notably those containing certain antiseptic agents, can be valuable in infection control and in promoting healing. This review states the case for taking the antiseptic route as part of the concerted approach to local wound management and infection control.