Skin lesions appear as nonspecific maculopapular eruptions that become hemorrhagic, but oral or cutaneous ulcers are sometimes present, particularly in the subacute, disseminated form of the disease. It may be sutured within a few days (delayed primary closure), or much later when the wound is clean and granulating (secondary closure), or left to complete healing naturally without suturing.Dressings designed to promote the wound healing process through the creation and maintenance of a local, warm, moist environment underneath the chosen dressing, when left in place for a period indicated through a continuous assessment process. Definitions of the severity of surgical site infections vary and this should be taken into account when comparing reported rates of surgical site infection.Clean: an incision in which no inflammation is encountered in a surgical procedure, without a break in sterile technique, and during which the respiratory, alimentary or genitourinary tracts are not entered.Clean-contaminated: an incision through which the respiratory, alimentary, or genitourinary tract is entered under controlled conditions but with no contamination encountered.Contaminated: an incision undertaken during an operation in which there is a major break in sterile technique or gross spillage from the gastrointestinal tract, or an incision in which acute, non-purulent inflammation is encountered. Clindamycin was found to be superior to penicillin in animal models, and 2 observational studies show greater efficacy for clindamycin than β-lactam antibiotics [112, 113]. and Because bacteria other than clostridia produce tissue gas, initial coverage should be broad as for necrotizing fasciitis until the diagnosis is established by culture or Gram stain. Most of the organisms originate from the bowel or genitourinary flora (eg, coliforms and anaerobic bacteria).The diagnosis of fasciitis may not be apparent upon first seeing the patient. Excellent results have been reported for gram-negative infections using broad-spectrum monotherapy with carbapenems, cephalosporins that possess antipseudomonal activity, or piperacillin/tazobactam.For patients in whom vancomycin may not be an option, daptomycin, ceftaroline, or linezolid should be added to the initial empiric regimen. The term “cellulitis” is not appropriate for cutaneous inflammation associated with collections of pus, such as in septic bursitis, furuncles, or skin abscesses. Clindamycin suppresses streptococcal toxin and cytokine production. The single published trial of antibiotic administration for SSI specifically found no clinical benefit [99]. Efforts were made to include representatives from diverse geographic areas, pediatric and adult practitioners, and a wide breadth of specialties. Yokomizo, Hajime Guideline: Assessment and Treatment of Wound Infection Note: This is a controlled document. ST-JEAN, GUY Patients with an early infection due to streptococci or clostridia have wound drainage with the responsible organisms present on Gram stain (Figure 2). These are typically larger and deeper than furuncles.Furuncles often rupture and drain spontaneously or following treatment with moist heat. Studies of subcutaneous abscesses found little or no benefit for antibiotics when combined with drainage [18, 21, 100, 101]. Veiga, Francisco

Barnauskas, Susan Penicillin should be added because of potential resistance of group A streptococci to clindamycin. Most published data indicate that penicillin is effective therapy and will “sterilize” most lesions within a few hours to 3 days but does not accelerate healing. Dhingra, Gitika A. A deep incisional infection involves the deeper soft tissue (eg, fascia and muscle), and occurs within 30 days of the operation or within 1 year if a prosthesis was inserted and has the same findings as described for a superficial incisional SSI. These later infections are most common among high-risk patients with prolonged and profound neutropenia and they should be considered in any patient with neutropenia and skin and soft tissue lesions suggestive of infection. The laboratory should be notified when tularemia is suspected because of the health risks posed to laboratory personnel. Infection in the surgical wound may prevent healing, causing the wound edges to separate, or it may cause an abscess to form in the deeper tissues. The revision of the HSE national guidelines for wound management is to ensure that the most up-to-date evidence is available to support the standardisation of care and encourage best clinical practice, and to contribute to improved patient outcomes.