Pertinent Insights On Diagnosing And Treating Infected Wounds

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A Few Examples Of C&S Reports And Appropriate Actions

1. Staph aureus with cefazolin: SUSCEPTIBLE. This report means that the isolated bacteria is sensitive to the first generation cephalosporin. It means that the organism is most likely MSSA and it is appropriate to treat the infection with cephalexin (Keflex), a first-generation cephalosporin.
2. Staph aureus with cefazolin: RESISTANT. This report indicates MRSA and one should treat it with doxycycline, clindamycin, trimethoprim/sulfamethoxazole or linezolid for oral therapy, or vancomycin, linezolid, daptomycin (Cubicin, Cubist Pharmaceuticals) or tigecycline (Tygacil, Pfizer) for IV therapy, based on the culture and sensitivity report.
3. Coagulase-negative Staphylococcus. This is a common skin flora and rarely a disease-causing agent. This could mean one of two things. You may not have taking a good enough culture sample to isolate the disease-causing bacteria. Alternately, this finding could mean the wound is not infected but is perhaps red and inflamed from other reasons. For example, one may consider an allergic reaction to the wound dressing.

Clinical Editor: Kazu Suzuki, DPM, CWS

   In addition, Dr. Suzuki would be more inclined to recommend admission if a patient is older or sicker. For example, he would consider admitting a patient who is 70 years or older, one with any comorbidities such as diabetes or cancer, or a patient who is immunocompromised or immunosuppressed for organ transplant.

   The last reason for admitting a patient to the hospital is to control pain but Dr. Satterfield notes this does not usually come into play for infected wounds because podiatrists are often treating patients with diabetic neuropathy. In Dr. Satterfield’s experience, patients with wound infections often have a vascular-related issue that led to the infection so she advises obtaining a consult for vascular studies. Since one cannot efficaciously get a vascular consult outside the hospital, she suggests getting a consult in house within a day or two.

   Dr. Satterfield says another advantage to hospital admittance is being able to refer the patient with an infected extremity for possible limb reperfusion as this may prevent a transmetatarsal amputation or an even higher amputation in these patients.

   Dr. Joseph is a consultant in lower extremity infectious diseases and a Fellow of the Infectious Diseases Society of America. He is affiliated with Roxborough Memorial Hospital in Philadelphia.

   Dr. Satterfield is the Director of Medical Education at the Western University College of Podiatric Medicine in Pomona, Calif. She is a Fellow and President-Elect of the American College of Foot and Ankle Orthopedics and Medicine.

   Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo, Japan.


1. Sibbald RG, Goodman L, Woo KY, et al. Special considerations in wound bed preparation 2011: an update. Adv Skin Wound Care. 2011; 24(9):415-36.
2. Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004; 39(7):885-910.
3. Levine NS, Lindberg RB, Mason AD Jr, et al. The quantitative swab culture and smear: a quick, simple method for determining the number of viable aerobic bacteria on open wounds. J Trauma. 1976;16(2):89-94.

   For further reading, see “How To Differentiate Between Infected Wounds And Colonized Wounds” in the July 2005 issue of Podiatry Today or “Essential Insights On Addressing Common Wound Dilemmas” in the November 2009 issue.

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