Controversies and challenges of chronic wound infection diagnosis and treatment

Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and non-healing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden (1). In developed countries billions of dolars are spent each year (2,3) for the repeated hospitalizations and expensive treatment of patients suffering from non-healing ulcers. The persistent pain, either spontaneous or induced by treatment (4), the malodour of the ulceration (5), the mobility restrictions (6), and the excessive exudate, significantly impair the patients` quality of life, who might also experience secondary mood disorders (50-75%) (6) or sleep disorders (69%) (7).
The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains such as methicillin resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamases (ESBLs) producing micro organisms, and multiple antibiotic resistant Pseudomonas aeruginosa(8).