The Risk of Infection and Indication of Systemic Antibiotics in Chronic Wounds.

Background: No definitive guidelines exist to assist clinicians in determining when a chronic wound is infected or at risk for infection, nor do guidelines exist to aid in determining the indication or duration of systemic antibiotics. The lack of widely accepted guidelines can lead to excessive and improper use of systemic antibiotics, which can contribute to adverse drug events and the rise of multidrug-resistant organisms. Implementing a simple tool to measure the risk of infection in patients with chronic wounds could help clinicians determine the indication and appropriate use of systemic antibiotics as well as potentially reduce the use of systemic antibiotics.

Objective: This evidence-based practice project aims to identify both chronic wounds at risk for infection and the risk factors associated with chronic wound infection, evaluate the use of systemic antibiotics in patients with chronic wounds, and reduce the use of systemic antibiotics in chronic wounds that are not infected or at risk for infection by implementing a Wounds at Risk (WAR) score for all patients admitted with chronic wounds.

Materials And Methods: In this pre- and post-observational study, a convenience sample of all patients admitted with chronic wounds over a 6-week period were given a WAR score based on electronic medical record observations. Data were collected on the use and indication of systemic antibiotics and were compared with the same data of a control group of patients admitted with chronic wounds during a 6-week period before project implementation. Other clinical, microbiological, and demographic data also were collected and compared between the 2 groups.

Results: Though not significant, the overall use of systemic antibiotics was decreased in the post-intervention group. A significant reduction was seen in wound-related indications for antibiotics, most notably in the "infected ulcer" category. Diabetic foot ulcers were at highest risk for infection, and pathogen or microbiological burden did not play a significant role in infection risk.

Conclusions: The WAR score can help guide clinicians in determining the need for antibiotics, thus helping to reduce unnecessary antibiotic exposure, which can reduce the incidence of adverse drug events and multidrug-resistant organisms.