Dr. David B. Raynor, Best Foot Forward, 02/26/13

An insult to tissue and compromise to the skin can result in an infection. Infections can become a difficult and even serious problem even in healthy individuals if not treated appropriately and timely.

Blisters, calluses, corns, cuts, scrapes, tears and punctures to the skin can allow bacteria to enter into the tissues, causing an infection. Of course, infections do not occur in every injury, but they can occur especially in the lower extremity, which is often exposed to a dirtier environment and sometimes is more difficult to wash/keep clean than the trunk, arms and head.

Drug-resistant pathogens are on the rise worldwide. Drug-resistant pathogens are not necessarily more virulent than their non-drug-resistant relatives; there are just simply fewer available drugs to treat them.

There are not many new drugs in the pipeline to treat this emerging problem for a number of reasons. 

This does not bode well for the future, but this is not the main focus of the column today. Drug-resistant infections are also difficult, as it takes valuable time to identify them.

For example, a patient presenting with an infected foreign body in the foot will likely be placed on generic cephalexin after the foreign body is removed and the wound is swabbed and cultured. A culture and sensitivity test is performed to identify the bacteria and what drugs kill them. The choice of antibiotic is based on these results.

The culture and sensitivity usually takes three days to give information, because it takes time to grow the bacteria and expose them to test antibiotics to see which ones they will be effective. A patient with a MRSA (methicillinase resistant staphylococcus aureus) infection placed on cephalexin will most likely worsen during the time it takes to obtain the test results, because MRSA will not be affected by cephalexin — it has adapted to it.

The delay or lag time it takes to get the information necessary to change to an appropriate antibiotic allows the bacteria to multiply and advance. The delay can sometimes lead to the need for hospitalization and intravenous antibiotics. Sometimes the delay or just the bacteria itself can lead to sepsis, amputation, or even death. Of course this is unusual, but can and does occur.

I am not suggesting that every wound will lead to serious problems. However, I am warning those at risk to be aware. Patients with diabetes, immunocompromised state and peripheral vascular disease are at an increased risk of complications from otherwise simple wounds and should be vigilant in addressing any wound immediately.

I am shocked and often angered by the lack of attention to the risk of infection from a wound in the population of people who are at risk.

I see many patients with diabetes, neuropathy and peripheral artery disease (PAD) for nail trimming and surveillance on a routine basis. Sometimes a patient will show up for their “routine” check-up and say that I also need to check a wound or problem area that has been bleeding or draining for two weeks.

This is disheartening and frustrating.

These issues in this patient population can lead to amputation and death. This is not a common occurrence, but it does occur and it is preventable with timely care in most cases.

A wound should be cleaned and addressed with topical antibiotics. The wound should be evaluated promptly by a health care professional if it is worsening, not responding to treatment, or the person is unable to treat it.

One should not look at the calendar and see a doctor’s visit scheduled in two to three weeks and simply wait for the appointment for it to be evaluated. Resistant infections are on the rise, and the available treatments are dwindling.

Often times, the difference between an uncomplicated simple cut, wound or splinter versus a more severe wound with infection requiring hospitalization, surgery or a protracted treatment course often boils down to timely care and addressing the problem rather than waiting.

David B. Raynor. DPM, is a podiatrist in Inverness and can be reached at 352-726-3668 with questions or suggestions for future columns.