Approach to infected skin ulcers.

OBJECTIVE To review the diagnosis and management of infected chronic skin ulcers. SOURCES OF INFORMATION Cochrane database, MEDLINE, and Google were searched for clinical practice guidelines (CPGs) for wound care. Most recommendations found in the CPGs had level II or III evidence. Expert and consensus opinion from the Canadian Chronic WoundAdvisory Board and the International Wound Bed PreparationAdvisory Board were also used. MAIN MESSAGE Bacteria in skin ulcersact along a continuum from contamination through colonization and critical colonization to infection. Critical colonization is not always associated with overt signs of infection but can result in failure to heal, poor-quality granulation tissue, increased wound friability, and increased drainage. Good-quality swab samples should be an adjunct to clinical acumen, not a primary strategy for diagnosis. Iodine and silver-based dressings, topical antibiotics, and systemic antibiotics can be helpful. CONCLUSION Diagnosis of chronic woundinfection is based on clinical signs and a holistic approach to patients. More research into assessment and treatment of skin ulcerinfection is needed.