Infection Management

Signs of Infection

Patients should seek medical attention if signs of a more serious infection develop, which may indicate the need for systemic antibiotics and possibly incision and drainage, according to the World Journal of Emergency Surgery 1
Superficial skin inflammation without significant signs of infection can be managed with local wound care without systemic antibiotics, as recommended by the World Journal of Emergency Surgery 1
Local signs of infection, such as pain, swelling, and purulent drainage, should be evaluated, as recommended by the Infectious Diseases Society of America 2
Systemic signs, such as temperature, pulse rate, and white blood cell count, should also be considered, as recommended by the Infectious Diseases Society of America 2, 3

The wound site should be cleaned with sterile saline or tap water irrigation to promote wound healing, as recommended by the American Heart Association 4
Occlusive dressings can be used for clean superficial wounds, as recommended by the American Heart Association 4
Topical antimicrobials can be used for superficial infections, as recommended by the Infectious Diseases Society of America 5
Antimicrobial dressings can be applied after drainage, as suggested by the Infectious Diseases Society of America 5

Antibiotics should be chosen based on likely organisms, with options including piperacillin/tazobactam, ertapenem, or a third-generation cephalosporin plus metronidazole, as recommended by the Infectious Diseases Society of America 2, 3
Wound cultures should be obtained before starting antibiotics, as recommended by the Infectious Diseases Society of America 5
Antibiotics should not be overused and should only be used when necessary, as recommended by the Infectious Diseases Society of America 2, 3
The duration of antibiotics for underlying infections, such as hepatic abscess, is typically 4-6 weeks, as recommended by the Infectious Diseases Society of America 6

For patients with erythema <5 cm around the drain site and minimal systemic signs, treatment involves opening the affected area if there is evidence of infection, draining any purulent material, and continuing dressing changes until healing occurs, without the need for antibiotics, as recommended by the Infectious Diseases Society of America 2, 3
For patients with erythema extending >5 cm from wound margins, temperature >38.5°C or pulse >110 beats/min, or evidence of deeper infection, treatment involves opening the incision, evacuating infected material, obtaining cultures, and starting a short course of antibiotics, as recommended by the Infectious Diseases Society of America 3
Deep infections should not be missed, and any surgical site infection (SSI) that doesn't resolve as expected should be investigated, as recommended by the Infectious Diseases Society of America 2
Drainage should not be delayed for significant infections, and the primary therapy for SSI is to open the incision and evacuate infected material, as recommended by the Infectious Diseases Society of America 3

Patients with infected wounds should be referred to wound care specialists for ongoing management, as recommended by the American College of Emergency Physicians 7
Consider surgical or enzymatic debridement for necrotic tissue, while avoiding aggressive debridement that could expose deeper structures, as suggested by the American College of Emergency Physicians 7
Dressing changes should be continued until healing occurs, as recommended by the Infectious Diseases Society of America 2, 3
Prompt surgical consultation should be considered if signs of systemic toxicity or necrotizing infection are present, as recommended by the Infectious Diseases Society of America 3