JAC Advance Access originally published online on January 13, 2005
Journal of Antimicrobial Chemotherapy 2005 55(2):143-149; doi:10.1093/jac/dkh513
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JAC vol.55 no.2 © The British Society for Antimicrobial Chemotherapy 2005; all rights reserved
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A review of the microbiology, antibiotic usage and resistance in chronic skin wounds
1 Wound Biology Group, Wales College of Medicine, Cardiff University, Cardiff CF14 4XY; 2 Department of Oral Surgery, Medicine and Pathology, Wales College of Medicine, Cardiff University, Cardiff CF14 4XY; 3 Wound Healing Research Unit, Cardiff Medicentre, Heath Park, Cardiff CF14 4UJ; 4 Infection and Communicable Disease Service, National Public Health Service for Wales, Temple of Peace and Health, Cardiff CF10 3NW; 5 Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff CF14 4XY, UK
* Corresponding author. Tel: +44-29-2074-4252; Fax: +44-29-2074-2442;Email: howell-jonesrs{at}cf.ac.uk
Chronic leg and foot wounds represent an increasing burden to healthcare systems as the age of the population increases. The deep dermal tissues of all chronic wounds harbour microorganisms, however, the precise interaction between microbes in the wounds and impaired healing is unknown. With regard to antibiotic therapy, there is a lack of evidence concerning its effectiveness, optimal regimens or clinical indications for treatment. Despite this lack of evidence, antibiotics are frequently a feature of the management of chronic wounds and these patients receive significantly more antibiotic prescriptions (both systemic and topical) than age and sex-matched patients. Current guidelines for antibiotic prescribing for such wounds are often based on expert opinion rather than scientific fact and may present difficulties in interpretation and implementation to the clinician. Although the increasing prevalence of antibiotic resistance is widely recognized, the relationships between antibiotic resistance, chronic wound microbiology and rationales for antibiotic therapy have yet to be determined. This review discusses the role of microbes in chronic wounds from a clinical perspective with particular focus on the occurrence of bacteria and their impact on such wounds. The evidence and role of antibiotics in the treatment of such wounds are outlined and current practice of antibiotic usage for chronic wounds in the primary care setting described. The implications of antibiotic usage with regard to antibiotic resistance are also considered.
Keywords: wound infection , wound healing , antibacterials
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