Stage 2-4 pressure ulcers are colonized with bacteria.
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Action |
Deal with necrotic material and exudates with wound cleaning (normal saline) and debridement when needed.
Remove the debris that supports bacterial growth.
DO NOT use surface swab cultures.
All wounds are colonized.
Consider a 2 week trial of topical antibiotics for ulcers continuing to have exudate after 2 weeks of appropriate wound care. Possible agents include; silver sulfadiazine, triple antibiotic and mupirocin.
Watch for allergic reactions to topicals.
See note. |
- Remove debris.
- Consider topical antibiotics.
- Watch for allergic reactions.
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Remember that topical antiseptics like povidone-iodine, hydrogen peroxide and acetic acid are toxic to healing cells.
DO use systemic antibiotics for sepsis, bacteremia, cellulitis and osteomyelitis.
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- Don't use topical antiseptics.
- Do use systemic antibiotics.
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Bacteremia/sepsis are commonly caused by Staph aureus, gram negative rods or Bacteroides fragilis.
If a patient with a pressure ulcer develops unexplained fever, tachycardia, hypotension, or mental status changes, rule out other causes, obtain blood cultures, consider needle aspiration or tissue biopsy of wound, treat with broad-spectrum antibiotics to cover above organisms1.
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- Rule out other causes.
- Obtain blood cultures.
- Consider needle aspiration.
- Consider tissue biopsy.
- Treat with broad spectrum antibiotics.
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References:
- Bergstrom N, Bennett A, Carlson CE, et al. clinical Practice guidelines Number 15: Treatment of pressure ulcers.
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