In the ever-changing world of wound care and nursing, it remains apparent that chronic wounds are a growing challenge. Evidence shows that age increases the likelihood of developing a chronic wound, which supports the notion that the burden of these wounds on the NHS is likely to further intensify with the ageing population. There are many reasons why a wound may fail to progress, including wound aetiology, comorbidities and environmental and socio-economic factors. One of the most significant reasons why wounds may fail to progress and become chronic is untreated wound infection. In order for clinicians to be able to treat and manage wound infections, it is vital that they understand how infection develops, the many ways in which infections may present themselves and how and when to initiate appropriate topical and systemic therapies to treat wound bed infections. The present article provides an overview of wound bed infections and their management.
The skin is one of the body's main barrier systems against microbes entering the body and multiplying. When the skin is compromised, for instance, if an injury which breaks that protective barrier is sustained, tissues in the wound bed become susceptible to microbial colonisation. If microorganisms are able to penetrate the skin and begin proliferating, local tissues are damaged, and the normal wound healing process can become disrupted.1 Wound infection can be defined as the presence of a wound environment characterised by microbes in sufficiently large numbers, or of sufficient virulence, to provoke an immune response locally, systemically or both.2
Gram-positive bacteria such as Staphylococcus aureus and Enterococcus spp, Gram-negative organisms such as Pseudomonas aeruginosa and Acinetobacter spp and fungi such as Candida spp and Aspergillus spp are all among the list of common pathogens that can cause acute wound infections, and several of them are resistant to antibiotics.3
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