Introduction to infections of chronic ulcers and wounds

All chronic ulcers and wounds are colonised with bacteria. Do not perform microbiological investigations or start antibiotic therapy unless there are clinical signs of infection (eg systemic features, spreading cellulitis; see also Ulcer and wound infection). If there are clinical signs of infection, collect samples of pus (which must be distinguished from ulcer exudate) or infected tissue for culture; culture of a superficial swab may identify organisms that are colonising the wound rather than causing infection (eg Pseudomonas aeruginosa identified by culture of a superficial swab of a lower limb ulcer).

For an overview of the approach to managing ulcers and wounds, see Fundamentals of ulcer and wound management.

For infections of chronic ulcers in patients with diabetes, see Infections of diabetes-related foot ulcers. For Mycobacterium ulcerans infection (Buruli ulcer), see Mycobacterium ulcerans infection (Buruli ulcer).