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Approach to chronic wound infections
D Leaper1, O Assadian2, C E Edmiston3
1Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, U.K.
Abstract:
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.
Insights
Infection significantly delays chronic wound healing, often due to biofilms. Topical antiseptics are more effective than antibiotics for managing wound infection and biofilms, reducing resistance risks.
Area of Science:
- Wound healing
- Infectious disease
- Antimicrobial resistance
Background:
- Infection is a primary cause of delayed healing in chronic open wounds.
- Biofilms complicate wound infection diagnosis and management, contributing to prolonged inflammation and delayed healing.
- Systemic infection, sepsis, and multiple organ dysfunction syndrome are life-threatening risks of neglected chronic wound infections.
Purpose of the Study:
- To review the role of infection and biofilms in chronic wound healing.
- To evaluate the efficacy of topical antimicrobials (antiseptics) versus antibiotics in managing chronic wound infections.
- To highlight the importance of controlling biofilms in chronic wound management.
Main Methods:
- Literature review on chronic wound infection, biofilms, and antimicrobial treatments.
- Analysis of the mechanisms of action for antiseptics and antibiotics.
- Discussion of antimicrobial resistance trends and their implications for wound care.
Main Results:
- Biofilms contribute to excessive inflammation and delayed healing in chronic wounds.
- Topical antiseptics demonstrate effectiveness through multiple mechanisms, making resistance development unlikely.
- Antibiotics should be reserved for severe infections due to rising antimicrobial resistance and a lack of new drug development.
Conclusions:
- Controlling biofilms is crucial for effective chronic wound management.
- Antiseptics are a preferred option for managing chronic wound infections and biofilms over antibiotics.
- Further research with randomized controlled trials is needed to support the use of antiseptic dressings for biofilm prevention and management.
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