The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice (original) (raw)

2019, International Wound Journal

This literature review aimed to provide a narrative review of evidence on validity of clinical and microbial indicators of infection and to gain insight of the diagnosis of infection in chronic leg ulcers. A search was conducted in Cinahl, Medline, the Cochrane Library databases, Embase, Web of Science, ScienceDirect, Pubmed, PsycINFO, ProQuest dissertations and Google Scholar from Januray 1990 to July 2017. The inclusion criteria were original studies, systematic reviews and consensus documents focused on "infection" in chronic leg ulcers, English language, clinical and community settings, and human. The reviewed studies were inconsistent in criteria for infection between investigated wound types and lack of specificity regarding wound types. There were few studies investigating the criteria for diagnosis of infection in leg ulcers. The identification of leg ulcer infection still remains problematic and relies on out-of-date and not uniform evidence. Literature in this area was mostly limited to level III and IV evidence based on The Australian National Health and Medical Research Council Levels of Evidence, or expert opinion. This literature review revealed seven clinical signs and symptoms that could be diagnostic for infection in chronic leg ulcers, including: new, increased or altered ulcer pain; malodour; increased ulcer area; wound breakdown, delayed or non-healing; erythema and increased local temperature, while the microbial indicators used to diagnose infected leg ulcers were varied and regarded as less important.