Challenges in the management of chronic wound infections.

OBJECTIVE Chronic wound infections may delay the healing process and are responsible for a significant burden for the healthcare system. Since inappropriate management may commonly occur in the management of these patients, this review aims to provide a practical guide underlining actions to avoid in the management of chronic wound infections.

METHODS We performed a systematic review of the literature available on PubMed in the last 10 years, identifying studies about the management of patients with chronic wound infections. A panel of experts discussed about the potential malpractices in this area. A list of Don'ts including the main actions to be avoided was drawn up through the Choosing Wisely methodology.

RESULTS In this review we proposed a list of actions to avoid for an optimal management of these patients. The adequate wound bed preparation and the wound antisepsis should be combined, because the absence of one of them lead to delayed healing and higher risk of wound complications. Moreover, avoiding inappropriate use of systemic antibiotics is an important point because of the risk of selection of multidrug resistant organisms and antibiotic-related adverse events.

CONCLUSIONS A multidisciplinary team of experts in different fields (surgeon, infectious disease expert, microbiologist, pharmacologist, geriatrician) is required for an optimal management of chronic wound infections. The implementation of this approach may be useful to improve the management of patients with chronic wound infections.