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The Lack of Reliability of Clinical Examination in the Diagnosis of Wound Infection: Preliminary CommunicationFrom the Penn North Centers for Advanced Wound care/NewBridge Medical Research, serena{at}healingwounds.com
Foot and Ankle Institute of South Florida, South Miami
Wound Healing Center at University Hospital, Tamarac (RS), Florida The diagnosis of infection in chronic wounds is challenging. Clinicians tend to rely on the classic signs and the symptoms. Quantitative tissue biopsy, the most accurate method, is rarely used because it is expensive, invasive, and difficult to perform. A recently completed clinical trial evaluating collagen/oxidized regenerated cellulose/antimicrobial matrix versus standard of care in venous leg ulcerations was reviewed. Patients with infected venous leg ulcers by clinical examination were excluded. In fact, none of the subjects in the 2 arms of the study had target ulcers that appeared to be infected at any time during the study. Quantitative biopsies of the ulcers were obtained and compared with investigator evaluation. In all, 14 of 49 subjects (28%) had bacterial counts greater than 105 or β-hemolytic streptococcus despite the lack of clinical signs of infection. This analysis suggests that clinical examination is unreliable in the diagnosis of wound infection in venous leg ulcerations.
Key Words: wound infection • venous leg ulcer • clinical trial
The International Journal of Lower Extremity Wounds, Vol. 7, No. 1,
32-35 (2008) |
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