Targeting lurking pathogens in acute traumatic and chronic wounds

The appropriate antimicrobial treatment for skin and soft tissue following acute trauma is determined by the mechanism of injury, time from injury to treatment, environmental wound contamination, pathogenicity of colonizing b acteria, and patient-specific issues. These factors can be used to predict the risk of secondary infection of wounds. Although common skin pathogens ( such as Staphylococcus aureus and group A Streptococcus) cause most seconda ry wound infections, antibiotic therapy sometimes must be directed against unusual pathogens that are associated with atypical wounds, such as animal bites (amoxicillin with clavulanate for Pasteurella multocida) and plantar puncture wounds (ciprofloxacin for Pseudomonas aeruginosa), This customized treatment approach is also appropriate for chronic wounds, such as pressur e and diabetic foot ulcers, In addition to antibiotic therapy, wound manage ment may include surgical debridement, Active areas of investigation in wou nd management include the use of growth factors and hyperbaric oxygen. (C) 1999 Elsevier Science Inc.