Skip main navigation

Case study 2 – assessment and treatment

Assessment and treatment of the wound infection.

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 a glycopeptide antibiotic and levofloxacin. 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
This article is from the free online

Antimicrobial Stewardship in Wound Management

Created by
FutureLearn - Learning For Life

Our purpose is to transform access to education.

We offer a diverse selection of courses from leading universities and cultural institutions from around the world. These are delivered one step at a time, and are accessible on mobile, tablet and desktop, so you can fit learning around your life.

We believe learning should be an enjoyable, social experience, so our courses offer the opportunity to discuss what you’re learning with others as you go, helping you make fresh discoveries and form new ideas.
You can unlock new opportunities with unlimited access to hundreds of online short courses for a year by subscribing to our Unlimited package. Build your knowledge with top universities and organisations.

Learn more about how FutureLearn is transforming access to education