Case study 2 - assessment and treatment.

Assessment of the wound showed the following results:

  • Vascular assessment: No arterial occlusions.

  • Infection: CRP: 253.7 mg/L; Patient has fever.

Result of bacterial sampling bone biopsy:

Staphylococcus aureus +++

Streptococcus viridans +++

Enterococcus faecalis +++

  • X-Ray: Old calcaneum fracture and strong inflammation present.

An x-ray of the wounded foot.

Spreading infection was present and was slowly evolving into a systemic infection with sepsis. As a result, treatment mainly involved aggressive debridement. Surgical debridement was performed in combination with bone biopsy for bacterial sampling.

Further local therapy included a necessity for thorough cleansing and disinfection of the wound. Negative Pressure Wound Therapy (NPWT) with instillation (polihexidine solution 4x/day) was started. Systemic broad spectrum antibiotic treatment was administered to also cover anaerobic bacteria. After the results of the bone biopsy were known, antibiotic treatment was switched to glycopeptide antibiotics and levofloxacine. Any pressure on foot was forbidden; the patient’s movement was restricted and was kept bed- and wheelchair- ridden.

An image of the foot 1 week after starting NPWT treatment.

Result after 1 week of NPWT with instillation

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This article is from the free online course:

Antimicrobial Stewardship in Wound Management

BSAC