I may tend toward over-utilization. When I have difficulty controlling the bioburden, I will use systemic antibiotics to help gain control, especially in the case of Pseudomonas. The thick soupy drainage from Pseudomonas will frequently wall the bacteria off from the topical antimicrobial dressing I may be using. This means the patient has little to no local other signs and symptoms of infection. And as we all are aware, an ischemic diabetic wound may not always reveal the classic S&S of infection.
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