Clinical signs of infection in an acute wound:
• New or increased pain
• Swelling
• Erythema
• Purulent exudate( or serous exudate with inflammation)
• Malodour
• Localised warmth around the site of the wound.
Signs of spread of a localised wound infection [ 5 ]:
• Extension of erythema( and development of cellulitis)
• Formation of an abscess
• Lymphangitis
• Crepitus in the soft tissues
• Breakdown or dehiscence( splitting open) of the wound.
On 9 March, biopsies and a swab were taken from the affected tissues.
Diagnostic results
The results of the biopsy showed the wound to be the outcome of a pressure sore abscess rather than neoplasia.
Treatment
Swabs were taken at 3 weeks, 7 weeks, 10 weeks, 12 weeks, 14 weeks, 16 weeks and 20 weeks into treatment( Table 4).
After the results of culture of each swab were available, the VS made a decision on the next stage of antibiotic treatment. Antibiotic therapy was selected based on the antimicrobial sensitivities of the isolated organisms( Table 5).
Table 4. Summary of swab microbiological findings.
Sample number |
Time point |
Microorganisms identified |
Comments |
1 9 March 3 weeks into treatment
2 28 March 7 weeks into treatment
3 28 April 10 weeks into treatment
Scanty Escherichia coli
Enterococcus faecalis
Moderate methicillinresistant Staphylococcus pseudintermedius( MRSP)
E. coli is a common commensal bacterium in healthy dogs and the environment. Presence likely due to natural colonisation or contamination from the bandage being open centrally
Another commensal skin bacterium, indicating possible colonisation rather than infection
MRSP poses significant health risks to the patient, owners and veterinary staff. Use of personal protective equipment by VNs and owners, and thorough disinfection of the consultation room after each visit, are required
4 17 May 12 weeks into treatment
5 30 May 14 weeks into treatment
Enterococcus faecalis –
Enterococcus faecalis –
6 14 June 16 weeks into treatment
7 31 July 22 weeks into treatment
Staphylococcus pseudintermedius aureus
No microorganisms identified
–
–
Table 5. Antibiotic treatments used in this case.
Pathogen Medication Dose rate Dose given
Escherichia coli |
Marbofloxacin 20 mg( Animalcare) |
2 mg / kg |
2¼ tablets |
|
|
|
twice a day |
Staphylococcus pseudintermedius aureus
Doxycyline 100 mg( Boehringer Ingelheim) |
10 mg / kg |
200 mg |
|
|
once a day |
38 Veterinary Nursing Journal