Infection in Venous Leg Ulcers: Considerations for Optimal Management in the Elderly

Abstract

Venous leg ulcers are the most common cause of chronic leg wounds, accounting for up to 70 % of all chronic leg ulcers and carrying with them a significant morbidity, especially for elderly patients. Among people aged 65 years and older, the annual prevalence is 1.7 %. Billions of dollars per year are spent caring for patients with these often difficult-to-heal and sometimes recurrent chronic wounds. Chronic non-healing wounds of the lower extremities are susceptible to microbial invasion and can lead to serious complications, such as delayed healing, cellulitis, enlargement of wound size, debilitating pain, and deeper wound infections causing systemic illness. Recognition and treatment of the infected venous leg ulcer is an essential skill set for any physician caring for geriatric patients. Most physicians rely on subjective clinical signs and patient-reported symptoms in the evaluation of infected chronic wounds. The conventional bacterial culture is a widely available tool for the diagnosis of bacterial infection but can have limitations. Systemic antibiotics, as well as topical antiseptics and antibiotics, can be employed to treat and control infection and critical colonization. Better understanding of microbial biofilms in the wound environment have caused them to emerge as an important reason for non-healing and infection due to their increased resistance to antimicrobial, immunological, and chemical attack. A sound understanding of the microbial-host environment and its complexities, as well as the pathophysiology of venous hypertension, must be appreciated to understand the need for a multimodality approach to treating an infected venous leg ulcer. Other treatment measures are often required, in addition to systemic and topical antibiotics, such as the application of wound bandages, compression therapy, and wound debridement, which can hasten clearance of the infection and help to promote healing.

Associations between patient, treatment, or wound‐level factors and venous leg ulcer healing: Wound characteristics are the key factors in determining healing outcomes

“…[9][10][11] Due to underlying etiology, VLU healing is commonly protracted, with 30% remaining unhealed after six months. 12 Because every day that a VLU is present doubles the cost of treatment 13 and increases the risk of infection, 14 understanding what factors aid or inhibit healing is needed to promote healing. The reduction in health services costs as a result of timelier healing has been calculated at AUD1.2 Billion in recent economic modeling estimates.…”

The Common Bacterial Infections in Patients with Leg or Hand Infections

“…treatment measures are often required, in addition to systemic and topical antibiotics, such as the application of wound bandages, compression therapy, and wound debridement, which can hasten clearance of the infection and help to promote healing [11].…”

Alginate films augmented with chlorhexidine hexametaphosphate particles provide sustained antimicrobial properties for application in wound care

“…Since 1980, the number of adults with type 2 diabetes has almost quadrupled, with lower and middle income countries the most affected [1]; 25% of these people will develop a diabetic foot ulcer in their lifetime, and 50% of those will become infected [2]. Venous ulcers are the most common chronic leg wounds, and prevalence rises with age, affecting 1.7% of people over 65 [3]. All of these chronic wounds can be considered to be colonised by bacteria; only some progress to clinical infection, and the factors which determine whether and when this occurs are not well understood, resulting in uncertainty as to how to best prevent and treat them [4].…”