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Clinical Signs of an Infected Wound

Early identification and subsequent treatment to reduce or eliminate infection is both clinically and economically beneficial. A holistic assessment, including a clinical evaluation of the wound is required. This should include assessing the anatomical location, presentation of the wound bed and the periwound region. Microbial burden is not always associated with signs and symptoms of infection.

Classic signs

  • Pain - new or increasing
  • Erythema
  • Local warmth
  • Swelling
  • Copious amounts of exudate
  • Malodour
  • Cellulitis
  • Pyrexia
  • Abscess formation

Additional signs

  • Increase in size of wound
  • Hypergranulation
  • Bleeding
  • Wound breakdown/dehiscence
  • Inflammation, swelling of lymph glands
  • Delayed wound healing
  • General unwellness
  • Epithelial bridging
  • Dark discoloured granulation tissue
  • Increased friability
  • Pocketing at base of wound
  • Crepitus
  • Lymphangitis

Signs of systemic infection

  • Malaise
  • Lethargy or nonspecific general deterioration
  • Loss of appetite
  • Fever/pyrexia
  • Severe sepsis
  • Septic shock
  • Organ failure

Note - If the systemic infection is not treated in a timely manner, there is a high risk of mortality. (Dowsett, 2011; WUWHS, 2008; IWII, 2022)

It may be difficult to identify infection in patients who have compromised immune systems or elderly patients who have infection with minimal symptoms.

A chronic wound will nearly always test positive for bacteria, as colonisation will be a certainty. Therefore, wounds should not be swabbed unnecessarily as this may cause trauma to new epithelialising or granulation tissue. However, swabbing should be done if the patient has any of the above signs.