SDL_5 Wound Microbiology

 List the common causative organisms that causes wound infection

 Describe the source and routes of transmission of wound infection caused by microorganisms
 Describe the clinical signs and symptoms of wound infection
 List the complications of untreated wound infection
 Outline the management and prevention of wound infection

Wound Infection

Types Info

Superficial skin infections - Occur primarily in the outer layers of the skin but may extend
deeper into the subcutaneous layer

Bites - Leads to wound infections which reflect the microorganisms

present in the saliva and oral cavity of the human or animal that
created the bite wound

Trauma - Injuries caused by physical force, examples: burns, motor

vehicle accidents, crushing injuries, cuts from knives and other
sharp instruments, and gunshot wounds

Post-surgical - Surgical sites are most commonly infected with the patient's
normal skin and/or gastrointestinal flora - the same organisms
seen with superficial infections

Burns - Burns may be caused by scalding or flammable liquids, fires and

other sources of heat, chemicals, sunlight, electricity, and very
rarely by nuclear radiation
LO 1 : Common bacteria causing wound infection (general)

Aerobic or facultative pathogens  Primary causes of delayed healing and infection in acute
& chronic wound

1. Staphylococcus aureus
2. Pseudomonas aeruginosa
3. Beta-hemolytic streptococci

Source of wound contaminants

1. Environment
- Exogenous microorganisms in the air or those introduced by traumatic injury

2. Surrounding skin (Normal skin microflora

- Staphylococcus epidermidis,
- Micrococci
- Skin diphtheroids
- Propionibacterium

3. Endogenous sources involving mucous membranes

- Anaerobic bacteria

Anaerobic bacteria can contribute to wound infection, such as

- Bacteroides
- Prevotella
- Porphyromonas
- Peptostreptococcus sp.

However, this is often overlooked due to 3 reasons

a. Anaerobes are not regarded as being detrimental to normal wound healing.

b. The culture, isolation, and identification of anaerobic bacteria is more time-consuming, labor-
intensive, and expensive and is often deemed to be too demanding for many diagnostic
microbiology laboratories.
c. Anaerobes are often perceived to die rapidly in air, hence having an effect on the method of
specimen collection and transportation to the laboratory
 Pathogens according to cause of wound infections

Wound infection Pathogen Add. Info

Superficial Normal flora bacteria - Ringworm, athlete’s foot-

skin infections - Staphylococcus (Staph) fungi Trychophyton sp
- Streptococcus (Strep)

Resistance strain
- Nappy rash- Yeast
- MRSA (Methicillin Resistant Staphylococcus aureus). infections by Candida sp

Special condition
- Brackish water wound infections  Waterborne Vibrio or
Aeromonas sp. - Common and plantar warts-
human papilloma virus
- Hot tub-associated infections  Pseudomonas (HPV).
aeruginosa.

- Deeper wound  Anaerobes  Bacteroides &

Clostridium sp.

Bites Normal oral flora - May cause Rabies

- Aerobic and anaerobic bacteria. Viral infection
- From dogs and cats
- Pasteurella multocida (Most common)

Trauma In deep puncture wound

- Anaerobic bacteria
- Clostridium tetani  cause tetanus

Post surgical - Same organisms as in superficial infections

Most common
- Resistance strain  MRSA
- Normal skin flora  S. aureus & S. epidemidis
- Gastrointestinal flora  Enterococci
- Bowel  Coliform bacilli

Burns - Normal skin flora - First-degree burns involve

epidermis.
 Fungal infection - Second-degree burns
- Candida penetrate to the dermis.

- Aspergillus - Third-degree burns penetrate

through all of the layers of the
- Fusarium skin and frequently damage
the tissues below it.
Viral infections
- Herpes simplex virus

LO 3 : Describe the clinical signs and symptoms of wound infection

Definition
- A sign is any objective evidence of disease as noted by an observer. (more precise)
- A symptom is the subjective evidence of disease as sensed by the patient.

Signs and symptoms

- In wound infection, inflammation is perhaps the most common sign and symptom

* Streptococcal infection might produce a sore throat (symptom) and inflamed pharynx (sign)
LO 4 : List the complications of untreated wound infection

- Cellulitis (bacterial skin infection)

- Fever
- Sepsis (blood infection)
- Impetigo 脓疱疮
- Abscess
- Necrotizing fasciitis (坏死性筋膜炎 - life-threatening bacterial soft tissue infection that spreads
along soft tissue planes rapidly)

LO 5 : Outline the management and prevention of wound infection

Wound management

1. Wound debridement (清创术)

Wounds that have devitalized tissue, contamination, or residual suture material require debridement
prior to further wound management.

Reason- to restore an optimal wound healing environment

Methods of wound debridement include

• Irrigation (washing out an organ or wound with a continuous flow of water or medication.)
• Surgical
• Enzymatic (Ex. Papain and collagenases)
• Biologic (Ex. Maggot therapy)

2. Medical care
o Antibiotics
o Glucose control

3. Wound packing

4. Topical therapy  Adjunctive therapies that may be helpful to augment wound healing.
5. Wound dressings
No single dressing is perfect for all wounds; rather, a clinician should evaluate individual wounds and
choose the best dressing on a case-by-case basis. In addition, wounds must be continually monitored
as their characteristics and dressing requirements change over time.

6. Wound closure
Primary closure refers to the direct apposition of skin edges of acute surgical or traumatic wounds
after appropriate wound preparation with sutures and/or staples
Another way may be through the process of healing by secondary intention, that might be assisted by
the use of negative pressure wound therapy.

7. Wound coverage
Example would be skin grafts to prevent fluid and electrolyte loss, and reduce bacterial burden and
infection.

8. Adjunctive therapies- example: Hyperbaric oxygen therapy

Prevention of wound infection

- Individual patient risk factors for wound infections, such as alcohol abuse, smoking or obesity
can usually only be modified to a small extent.

- Studies have shown a reduction of surgical site infections due to the implementation of a
benchmarking surveillance system.

- In order to prevent surgical site infections a variety of interventions are available, such
as glucose control, correction of anemia and malnutrition and antibiotic therapy of

infections before elective surgery.

- Reduction of the microbial skin flora by whole body washing procedures, avoidance of sharp

razor shaving, application of antibiotic prophylaxis and correct surgical hand disinfection are
additional measures.
- Intraoperative hypothermia should be avoided and strict compliance with asepsis is mandatory.

- Postoperative preventive measures include appropriate wound care and rapid removal of
wound drainage
 Question

1. Which of the following is the most common sign of a wound infection?

A. Inflammation

B. Malaise

C. Leukocytosis

D. Septicemia

2. Cellulitis is a complication of wound infection, if left untreated. True or False

3. Wound debridement increases the risks of wound infection. True or False

4. Chills is considered a sign, instead of a symptom. True or False

* Chill is a symptom ; Fever is the sign

5. The reason anaerobic bacteria is overlooked as a potential source of wound contaminants is due to
the fact that the culture, isolation, and identification of anaerobic bacteria is more time-consuming,
labor-intensive, and expensive. True or False.