Wound and Skin Infections
What?
Wound and skin infections mean that tissues are invaded by one or more types of microorganisms. This infection triggers the body's immune system, causing inflammation and tissue damage, as well as slowing the healing process. Most infections are confined to a small area, such as an infected scratch or hair follicle, which usually passes on its own. Others may persist and, if left untreated, the infection becomes severe, spreading further distances and / or deep tissues throughout the body. Some infections may spread to other organs or cause septicemia.
Skin is the body's largest organ and the first line of defense. The surface of the skin is not sterile even if it is clean. The surface is filled with a mixture of microscopic organisms called normal flora. This normal flora helps keep other harmful microscopic organisms (pathogens) away. At any given time, a certain percentage of the general population will be carriers of a pathogen that displaces a portion of normal flora and forms colonies in places such as mucous membranes of the nose. Normally, normal flora and colony-forming pathogens do not cause discomfort and do not stimulate the immune system. If there is a skin crack or the immune system is at risk, it can cause any existing microscopic live wound or skin infection.
Wounds are caused by disruption of skin and tissue integrity. They can be superficial cuts, scratches or abrasions, holes, burns, as well as surgical or dental treatments. The possibility that microscopic organisms can cause infection depends on the width and depth of the wound, the environment in which the wound occurs, and the microbes present in the skin of the person. The skin consists of three layers: the outer epidermis, the dermister glands and the hair follicles, and the subcutaneous layer. Below these layers are membranes that protect connective tissues, muscle and bone. Wounds can penetrate any of these layers, and skin infections can spread into these wounds. Wound healing is a complex process involving systems, chemicals and cells that work together to clean the wound, close the edges, and create new tissues and blood vessels.
Skin and wound infections may interfere with the healing process and cause additional tissue damage. Although it may affect everyone negatively, people who have slowed wound healing due to immunosuppression or poor circulation are at greater risk. Infections can become difficult to treat and become chronic infections when they penetrate into tissues deep in the body, such as bones, or occur in inadequate circulation.
About Wound and Skin Infections
Types of Wound Infections and Microorganisms
Wounds can be grouped according to the cause, the environment in which they occur, their extent, and whether they are clean or dirty. Typically, microorganisms that infect wounds and skin depend on which is present in the environment, the state of the individual's immune system, and the depth of the wound.
Bacteria, fungi and viruses can cause skin and wound infections. Bacteria can be separated according to the environment in which they multiply. Aerobic reproduction in air, microaerophilic growth in low oxygen environments, anaerobic bacteria that grow in environments with little or no oxygen are called. Deep wounds and abscesses may contain microaerophilic and anaerobic bacteria.
Superficial skin infections
Superficial infections occur mainly in the outer layers of the skin, but may progress deeper into the subcutaneous layer. Deeper wounds may also be infected with anaerobes, with the primary cause being aerobic microbes.
Bacterial infections are typically caused by normal flora bacteria such as Staphylococcus (Staphylococci) and Streptococcus (Streptococci). Colony forming bacteria and antibiotic resistant bacteria such as MRSA (Methicillin Resistant Staphylococcus aureus) can also cause infections. Wound infections in mild saline waters may be due to waterborne Vibrio or Aeromonas species. Pseudomonas aeruginosa may be the cause of infections associated with hot water pools and whirlpools. In deeper wounds, pathogens such as anaerobic bacteria such as Bacteroides and Clostridium species can be detected.
Typical bacterial skin infections:
Folliculitis, furuncles and carbuncles
Impetigo — skin lesions and vesicles
Pressure sores (bed sores) and ulcers bu can be detected in patients who remain inactive for long periods of time, such as long-term nursing home patients. Since such wounds can contain many different bacteria, culture tests do not provide useful information on how the patient should be treated.
Cellulite bir is an inflammation that causes redness, warmth and swelling, often involving subcutaneous and connective tissue.
Necrotizing fasciitis - a serious but uncommon infection that can rapidly spread and destroy the fascia, a layer of tissue that surrounds skin, adipose tissue, muscle tissue, and muscle groups. Often this type of infection is caused by Group A streptococci, sometimes called “meat-eating bacteria”.
Other common skin infections, called hair breakers and athlete's feet, are not bacteria but fungi. Spines, splinters and dead plants can be found on fungi and can lead to wound infections of the vein. Specific cultures are needed for their identification and identification. Yeast infections can occur with Candida species in the mouth (thrush) or in other moist areas of the skin.
Common warts, such as palms or soles of the feet, are caused by human papilloma virus (HPV).
Bites
Wound infections caused by bites are caused by microbes in the saliva and oral cavity of the human or animal forming the bite wound. The agents comprise one or more aerobic, microaerophilic and / or anaerobic microbes.
Human bites may be infected with various aerobic and anaerobic bacteria as part of normal oral flora. The majority of animal bites are made by dogs and cats, and Pasteurella multocidaptans are the most common cultures. Rarely, there is a risk of rabies infection from unvaccinated animals.
Trauma
Trauma includes a wide range of injuries caused by physical forces. It includes everything from burns to traumas (injuries in traffic accidents, crush injuries, cuts with knives and other sharp tools, and gunshot wounds). The type of infections in which trauma victims are caught depends primarily on the environment in which the injury occurs, the size of the injury, the microbes present on the patient's skin, the germs exposed during wound healing, and the general health and immunity of the individual.
Wounds, which can be contaminated initially, such as in motor vehicle accidents, or where extensive tissue destruction, such as severe burns, are at risk of infection. The presence of multiple aerobic and / or anaerobic bacteria in deep and contaminated wounds is not uncommon.
A deep puncture wound will allow bacteria such as Clostridium tetani (tetanus agent) to multiply. Since most of the population in Turkey is immunized against tetanus, tetanus is a very rare event. Vaccination against tetanus needs to be updated every ten years In the emergency room, where deep wounds that may require suturing are treated, the patient is often re-vaccinated against tetanus.
After surgery
Surgical sites are mostly infected with normal skin and / or gastrointestinal flora of the patient. The same microbes are seen in superficial infections. Infection may also result from exposure to microbes in the hospital environment. Bacteria such as hospital-acquired MRSA often show high resistance to antibiotics. Deep surgical wounds can be infected by both superficial aerobic microbes and anaerobic microbes found in the deep tissues of the body.
burns
Burns can occur with hot or flammable liquids, fires and other sources of heat, chemicals, solar radiation, electricity and very rarely nuclear radiation. First degree burns involve the upper skin (epidermis). Second degree burns penetrate into the skin. Third degree burns cross all layers of the skin, often causing damage to the underlying tissues.
Although the burn wounds were initially sterile, the patient's normal flora quickly formed colonies because of the dead tissue-escar (crust) in the centers and the skin being unprotected. The patient is at increased risk of wound infection, sepsis and multiple organ failure. Initially, bacterial infections occur. Fungal infections with Candida, Aspergillus, Fusarium and other species may occur if not prevented by antibiotic treatment. Infections caused by herpes simplex virus may also occur.
Symptoms and signs
General signs and symptoms of a wound infection include redness, swelling, local sensation of temperature, tenderness, and pus discharge. In the area concerned, the skin may become stiffened or stretched, and red streaks may form radially outward from the wound. Wound infections cause fever, especially when spread through blood. Skin infections can often cause redness or discoloration of the skin and pus, crusting, pain and / or itching.
tests
The doctor diagnoses many minor and superficial skin and wound infections based on clinical evaluation and experience. In addition to the general symptoms, many skin infections have characteristic signs such as athlete's feet in typical localities such as warts and toes on the soles of the feet. However, the clinical evaluation cannot tell the doctor exactly which microorganism is causing wound infection and which treatment they may be sensitive to. Laboratory tests are required for this.
Laboratory tests
Laboratory tests are primarily used to diagnose bacterial wound infections, identify responsible microorganisms, and determine possible susceptibility of certain antibiotics. Sometimes testing is performed to detect and identify fungal infections. To collect the sample, cells or pus are collected by applying a buffer to the surface of the wound, or the liquid or pus is aspirated with a needle or syringe and / or a biopsy tissue sample is taken. When anaerobic microbes are suspected, special sample collection and transport precautions should be applied to protect the sample from exposure to oxygen. Skin scrapings can be collected for fungal evaluation.
The test may include:
Bacterial wound culture: - The primary test used to diagnose bacterial infection. The sample is seeded into and onto the nutrient medium and allowed to stand at room temperature for the growth and identification of any bacteria present in the sample. Part of this test includes the identification of MRSA, if any. The results of bacterial wound cultures are usually obtained within 24-48 hours. It may be necessary to wait several weeks to obtain the results of specific cultures of slow-growing organisms such as fungi or mycobacteria.
Gram stain - Applied with wound culture. The special dye allows the bacteria to be evaluated under a microscope. These bacteria in their form - cocci (round) or rods; color can be divided into Gram-positive or Gram-negative bacteria. These test results should be taken on the day the samples are delivered to the laboratory. The laboratory can detect the quality of the sample and the potential bacteria that can cause infection.
Antibiotic susceptibility test - Test of wound culture results. When the causative agent is identified and isolated from the wound culture, this test is used to determine the possible susceptibility of the bacterium to certain drug treatments. This information helps guide the physician in selecting the appropriate antibiotic for treatment. These results can also be obtained about 24 hours after identification of the infection-causing microbe.
Other tests that may be requested:
KOH preparation - Prepared for microscopic examination of the fungal components (cellular structures) in the sample.
Fungal culture - Desirable when a fungal infection is suspected. Since many fungi produce slowly, it can take several weeks to identify.
ARB culture and swab test - Desirable when mycobacterial infection is suspected.
Blood culture - Desirable when sepsis is suspected.
Urine culture - Desirable when urinary tract infection is suspected.
DNA or RNA testing is performed to determine the genetic content of the specific microbe.
Examinations other than laboratory tests
In some cases, imaging scans such as ultrasound or radiological examinations may be required to assess the extent of tissue damage and to look for fluid / inflammation areas.
therapies
The risk of wound infection can be minimized by immediate and appropriate wound cleaning and treatment. Most wound infections can be treated successfully.
Many superficial bacterial and virus infections will go away on their own. Other bacterial infections may require only topical antibiotics. Some cases require incision and drainage. Deeper infections and stubborn patients typically require oral antibiotic therapy. The choice of antibiotic to be used is based on wound culture and antibiotic susceptibility tests. Antibiotic-resistant bacteria or an infection that is difficult to penetrate into drug therapy may require a wider treatment and / or treatment with intravenous drugs.
Wounds sometimes require removal of many dead tissues (debridement) and / or drainage. Topical antibiotics and removal of dead tissue are also used to treat burns. In large injuries, patch surgery (grafting) or other surgeries may be necessary.
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