Infection management


Once the skin is broken the patient is at great risk of infection as there is a clear portal of entry for invading bacteria.1

Diagnosis Management


The local signs of infection include:1

  • Malodour
  • Grey/yellow tissue at base of ulcer
  • Purulent discharge

  • Undermining of wound edge
  • Visible tendon or bone
  • Sinuses within the ulcer

In some instances these signs may not always manifest in an infected wound. Additional criteria have been identified and validated by an international multidisciplinary group of 54 experts using the Delphi approach. The following key criteria for the diabetic foot have been highlighted in the 2005 European Wound Management Association position document on infection:2

Criteria for wound infection 2


According to the 2006 European Wound Management Association position document on "Management of wound infection" the principles of infection management are to:5

  • "Provide an environment to promote rapid healing
  • Minimise the use of antimicrobial agents that may adversely affect human cells
  • Use antimicrobial agents appropriately to reduce the selection of resistant strains
  • Restrict the use of systemic agents to when they are specifically indicated
  • Avoid topical sensitisation or allergic reactions"

The choice of dressing to minimise the risk of infection is important. "Decisions need to be based on the ability of the dressing to:

  • Manage increased exudation
  • Remove necrotic tissue
  • Reduce malodour
  • Conform to the site and shape of the wound
  • Perform wound bed preparation functions
  • Satisfy patients' expectations
  • And meet treatment goals" 5


  • Cellulitis
  • Lymphangitis
  • Phlegmon
  • Purulent exudate
  • Pus/abscess


  • Crepitus in the joint
  • Erythema
  • Fluctuation
  • Increase in exudate volume
  • Induration
  • Localised pain in a normally asensate foot
  • Malodour
  • Probes to bone
  • Unexpected pain/tenderness


  • Blue-black discoloration and haemorrhage (halo)
  • Delayed/arrested wound healing despite offloading and debridement
  • Deterioration of the wound
  • Friable granulation tissue that bleeds easily
  • Local oedema
  • Sinuses develop in an ulcer
  • Spreading necrosis/gangrene
  • Ulcer base changes from healthy pink to yellow or grey

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