Causes, signs and treatment of infected wounds

One of the most common complications of any injury is a wound infection. Wound infection is quite common and can be related to the nature of the wound, the speed of medical care, and the casualtys compliance with antiseptic rules.

What is an infected wound

An infected wound is one in which conditionally pathogenic or pathogenic bacteria, protozoa, and fungi are detected.

As a rule, the presence of infection becomes noticeable a few days after the wound, when symptoms of inflammation begin to appear.

An exception is soft tissue lesions that initially contain foreign particles, which is guaranteed to indicate the entry of microflora.

Types of possible infections

There are several classes of wound infections. The division is based on the nature of the pathogen and the symptoms it causes:

• Purulent infection. Caused by pathogenic or opportunistic microorganisms. In most cases, these are all kinds of cocci living in the environment, on the skin or on clothing. Once in the wound, they lead to the development of inflammation with the release of pus;
• Putrefactive infection. Caused by Escherichia coli, Pseudomonas aeruginosa. These bacteria lead to tissue putrefaction, which causes extensive damage to peri-wound structures and intoxication;
• Specific microflora. Characteristic of wartime wounds (gunshot wounds, splinter wounds). Tetanus and anaerobic microorganisms penetrate into the wound with metal bodies. This can lead to CNS damage, development of gas gangrene;
• Rare forms. Wound infections are caused by scarlet fever, diphtheria, tuberculosis, and syphilis. At present, due to the widespread use of antibiotics and inoculation of large populations, these complications are extremely rare

Causes of wound infection

There are three main causes of infection:

1. Entry of foreign bodies, particles of soil during trauma. With timely and complete primary surgical treatment, the risk of further infection is minimized. Delaying wound care by at least 1 to 2 days greatly increases the risk of infection and inflammation;
2. Inadequate surgical treatment. In complicated wounds, especially in shrapnel-explosive lesions, there is often blood infiltration into wound pockets containing infectious agents. These formations combined with small (1 – 2 mm) particles are sometimes extremely difficult to detect, which leads to the development of wound infection;
3. Violation of the rules of wound care. Lack of constant washing, timely replacement of dressing material, moving with a wound that has not finally healed outside the hospital leads to secondary infection.

Signs and symptoms

The symptomatology of the infectious process is manifested by all the characteristic components of inflammation. At first, the edges of the wound and the skin around it become red, there is swelling, edema, and a local increase in temperature is observed. Painful sensations gradually appear, first when pressing and touching the inflamed area, later at rest. If the infectious process continues, both local and general symptoms may develop:

• Purulent contents may be excreted from the wound. In other cases, phlegmon – inflammation of fatty tissue, spreading over large areas (subcutaneous fatty tissue phlegmon of the leg, hip, shoulder area, etc.) – is formed;
• General well-being worsens, symptoms of general intoxication develop: weakness, fever or chills, increased body temperature, sweating. In particularly severe cases, sepsis and distant foci of infection in the internal organs may develop.

Please note! In both acute and chronic infectious process microflora can spread with the blood or lymph flow. Thus, caries can contribute to the development of myocarditis, wounds of the lower extremities lead to kidney abscesses, etc. Because of such complications, any infection must be eliminated as soon as possible by any available methods.

First aid

First aid can be given only in the first 24 hours. In this case, the risk of developing a wound infection is not completely eliminated, but only slightly reduced. Attempts to get rid of the pathogenic microflora on your own do not make any sense.

If you have been wounded and there is evidence of infection, it is necessary:

• Treat the wound with an antiseptic (chlorhexidine, iodine solution, alcohol solution (not 96%!), etc.);
• Apply a bandage or cotton-gauze sterile dressing to the injured area;
• Conduct dressing changes every 6 to 12 hours until surgical care is obtained.
• Only loosely placed particles that move on their own or when rinsed with antiseptic can be removed from the wound. Forcibly trying to tear out or pull away dirt particles or metal foreign bodies is by no means permissible.

Diagnosis of infectio

Determining the presence of an infectious inflammatory process in the wound is not difficult due to the specificity and severity of clinical signs. Detection of the pathogen and its sensitivity to antibiotics is much more important. For this purpose, a smear is taken with its subsequent culture, cultivation and determination of sensitivity of microorganisms to various antibacterial agents.

Treatment of infected wounds

Attempts to eliminate pathogenic microflora in the wound cannot be strictly divided into conservative and surgical ones. This is due to the fact that the first type of treatment in one way or another uses wound drainage, its constant washing with medications, which cannot be called a strictly conservative approach. Direct surgical treatment uses several more radical techniques.

Conservative therapy

Before obtaining information about the nature of the microflora and its sensitivity, an empirical prescription of broad-spectrum antibiotics is made. As a rule, these are cephalosporins (cefixime, ceftriaxone), which currently have the widest spectrum of activity.

After information about the sensitivity of the bacteria to antibiotics is obtained, the prescription can be adjusted.

Please note! In any infectious process with an unidentified causative agent, an empirical, intuitive, prescription of antibacterial therapy is initially carried out. This is necessary for the earliest possible start of exposure to the pathogenic microflora.

In addition to general treatment, local procedures are used. They consist of daily irrigation of the wound cavity with antiseptics (hydrogen peroxide, chlorhexidine, iodonate, etc.) through the drainage system, treatment of its edges with antibacterial ointments (Levomekol) and dressings.

Surgical treatment

There are two types of surgical wound care:

1. Primary surgical treatment is performed immediately after injury and consists of excision of wound edges, removal of foreign particles, dead tissues, and blood clots;
2. Secondary is aimed at the maximum removal of pus from the wound by opening purulent seepage, abscesses and placing a drainage system.
3. After the infectious process is eliminated, the wound is healed by secondary tension. It consists of gradual bringing the edges together and suturing the cavity.

Prevention of infection

In order to prevent wound infection, surgical care should be sought primarily within the first 6 hours of injury. In the postoperative period it is necessary to maintain personal hygiene, avoid contact with other patients with inflammatory processes, and not to neglect hospital regimen (dress the wound in time, do not leave the hospital on your own).