Infectious Disease consult recommended
These complex infections often require multidisciplinary management, including wound care and surgical specialties
Staphylococcus and Streptococcus are still the most important pathogens.
Consider deeper infection (osteomyelitis, septic arthritis); a wound that probes to bone = osteomyelitis.
Chronic wounds are not necessarily infected – assess for increased pain, erythema, warmth, edema, purulence, and signs of systemic toxicity.
Tissue specimens (i.e. bone) for culture are often needed to guide therapy and are more reliable than superficial wound swabs.
If deep infection is suspected and it is safe to wait (patient is systemically well), antibiotics should be delayed until after a tissue/bone specimen is obtained for culture.
Plain radiograph is the best first test.
Nuclear testing (bone scan and WBC scan) have a high false positive rate for lesions contiguous with the skin and are generally not required.