Management of bacterial colonization and infection algorithm

Management of bacterial colonization and infection algorithm

Management of bacterial colonization and infection algorithm Treatment Treatment

«Flowchart»

Ulcer evaluation

Ulcer evaluation

Ulcer evaluation

Ulcer cleansing and debridement

Ulcer cleansing and debridement

Ulcer cleansing and debridement

Ulcer not infected

Ulcer not infected

Ulcer not infected

Ensure complete cleansing and debridement

Ensure complete cleansing and debridement

Ensure complete cleansing and debridement

Purulent discharge, foul odor, or periulcer inflammation?

Purulent discharge, foul odor, or periulcer inflammation?

Purulent discharge, foul odor, or periulcer inflammation?

No

No

No No

Yes

Yes

Yes Yes

Monitor healing

Monitor healing

Monitor healing

End

End

End

Purulent discharge, foul odor, or periulcer inflammation continues?

Purulent discharge, foul odor, or periulcer inflammation continues?

Purulent discharge, foul odor, or periulcer inflammation continues?

No

No

No No

Yes

Yes

Yes Yes

Ensure complete cleansing and debridement

Ensure complete cleansing and debridement

Ensure complete cleansing and debridement

Systemic antibiotics

Systemic antibiotics

Systemic antibiotics

2-week trial of topical antibiotic

2-week trial of topical antibiotic

2-week trial of topical antibiotic

Is ulcer healing properly within 2 to 4 weeks?

Is ulcer healing properly within 2 to 4 weeks?

Is ulcer healing properly within 2 to 4 weeks?

Yes

Yes

Yes Yes

No

No

No No

Is ulcer healing?

Is ulcer healing?

Is ulcer healing?

Yes

Yes

Yes Yes

No

No

No No

Obtain quantitative bacterial cultures and evaluate for osteomyelitis

Obtain quantitative bacterial cultures and evaluate for osteomyelitis

Obtain quantitative bacterial cultures and evaluate for osteomyelitis

Tissue bacterial count >10⁵?

Tissue bacterial count >10⁵?

⁵ Tissue bacterial count >10[5]?

Return to node with red border

Return to node with red border

Return to node with red border

Osteomyelitis?

Osteomyelitis?

Osteomyelitis?

Reassess patient, treatment plan, and ulcer (i.e., return to first node)

Reassess patient, treatment plan, and ulcer (i.e., return to first node)

Reassess patient, treatment plan, and ulcer (i.e., return to first node)

Return to node with red border

Return to node with red border

Return to node with red border

No

No

No No

Yes

Yes

Yes Yes

No

No

No No

Yes

Yes

Yes Yes

^*Suspicion of sepsis requires urgent medical evaluation and treatment. Treatment of sepsis isn't discussed in this guideline.

^*Suspicion of sepsis requires urgent medical evaluation and treatment. Treatment of sepsis isn't discussed in this guideline.

^*Suspicion of sepsis requires urgent medical evaluation and treatment. Treatment of sepsis isn't discussed in this guideline.

^*

Cellulitis, sepsis, or osteomyelitis present?

Cellulitis, sepsis, or osteomyelitis present?

Cellulitis, sepsis, or osteomyelitis present?

No

No

No No

Yes^*

Yes^*

Yes^* ^* ^* Yes