Wound Infection: Pathological Basis, Sources, Antibiotics, and Treatment

This article discusses the pathological basis of wound appearance, sources for contamination of the wound, endogenous and exogenous sources, mode of transmission, the rationale of choice of antibiotics, mode of action of dicloxacillin, adverse reactions, and the treatment process of Mary's wound. The article also includes references for further reading.

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Table of Contents
Pathological basis of wound appearance....................................................................................1
Sources for contamination of the wound...................................................................................2
Endogenous Sources...............................................................................................................2
Mode of transmission..........................................................................................................2
Exogenous sources.................................................................................................................2
Mode of transmission..........................................................................................................3
The rationale of choice of Antibiotics........................................................................................3
Mode of action of dicloxacillin..............................................................................................4
Adverse reaction.....................................................................................................................4
The treatment process of Mary's wound....................................................................................4
References..................................................................................................................................6

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Pathological basis of wound appearance
A wound is an injury to the body that includes laceration or damage to the membrane.
Wound drainage also is known as the wound fluid or exudate. The wounds remain open may
exhibit different types of drainage like serous, sanguineous, serosanguineous and purulent.
The purulent type of drainage is milky in appearance. This type of drainages considered as
the sign of having an infection. This type of wound fluids are thick and opaque and may also
appear as green, yellow, white or brown in color. The drainage changes color and its
thickness due to the number of dead or living germ cells, as well as WBC (white blood cells)
present in the fluid (Wound Source, 2017). The patient in the given case study suffers from
extreme pain, and red swollen and worm wound. Person healing from the injury generally
finds their pain decreasing over time, if the patient feels the pain increasing continuously, that
is a clear sign of infection (Craft & Gordon, 2015). As discussed in the case the patient has
used her handkerchief to stop the bleeding from the wound. This might be the reason of
causing infection in the wound. The redness near the wound appears as the body tries to heal
the wound with the natural inflammatory process. It generally reduces with time, if not then it
also can be a sign of infection. Swelling of the wound is natural like redness which occurs at
the initial stages of the process of wound healing. Sometimes it takes more time to reduce or
increase with time this happens due to the microbial infection (Marieb & Hoehn, 2016). It is
normal to feel the skin somewhat warmer near the wound. When the skin near the wound
does not reduce its warm feel, this is because the immune system of the body fights back with
the microbial infection (Bullock & Manias, 2017). The heat is generated by the secretion of
vasoactive chemicals raised the blood flow the affected area and body's defense mechanism
generates more heat as it sends lymphocytes to produce more antibodies to kill the pathogen,

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this process of killing foreign invaders is called phagocytosis (Bessa, Fazii, Di Giulio, &
Cellini, 2015)
Sources for contamination of the wound
There are two different sources of contamination of wound named endogenous and
exogenous
Endogenous Sources
In the endogenous infection, the person gets infected by microorganisms from their
own normal flora. There is a number of microorganisms are present on human skin,
According to Reichman and Greenberg (2009), nearly three million bacteria are there per
square centimeter of skin. The most common microorganisms causing wound infection
belongs to Staphylococcus and Escherichia species. The Pathogens that cause infection are
previously harmless and become pathogenic after entering the body tissues. For example,
Escherichia coli that normally derived from the bowel may cause infection.
Mode of transmission
This happens due to the breakdown of the barrier between the sterile and no sterile
tissues of the body. The microbes are present on skin, mouth, nose, throat, female genital
tract and in the gastrointestinal tract. When the body's local or general resistance is reduced
these pathogens invade the body and cause infection. The microbes can be transferred to the
wound with sweat and unwashed hands (Koutoukidis, Stainton, & Hughson, 2016).
Exogenous sources
Exogenous sources of contamination of wound are the sources in which the patient's
wound is infected by microbes entered the body form their own environment. This can be
occurring in hospitals as well as at home. The bacteria with transient flora present

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superficially on the skin surface are acquired readily after the spreading in the environment,
including other people. The microbes easily become dislodged and spread from one location
to other, leads to exogenous infection (Anderson & Kaye, 2009).
Mode of transmission
The microbes like Staphylococcus aureus can transfer via indirect, direct or airborne
routes. The most important mode of transmission from one person to other person is by
indirect contact, for example by the handshake. Direct contact such as an airborne route can
also cause transmission of bacteria. It is estimated that a single scale from a carrier of
staphylococcus can transfer nearly 100 bacteria to another person. The single scale than
become airborne and settle on the hands of the person or on drapes then reach to the wound.
Humans can also get infected with the organism present in the inanimate environment.
Organisms with the life cycle stage in which they use insect vector allow the microorganism
to transmit to the wounds by insect bitting (Bullock & Manias, 2017).
The rationale of choice of Antibiotics
Antibiotics are proven therapy for the treatment of wound infection and prophylaxis
to stop the infection. The administration timings, choice of the antimicrobial agent, and
duration of administration clearly show the benefits of antibiotics in decreasing the wound
infection. The antibiotics and antiseptics are used to kill or slow the colonization of the
infection causing microorganisms which and prevent it from spreading. This helps the wound
to heal faster There are various types of antibiotics for infected wounds such as cephalexin,
Amoxicillin, Augmentin, dicloxacillin, ampicillin, and oxacillin (Sukumaran, & Senanayake,
2016). As mentioned in the case study the patient’s medication has been replaced with
Dicloxacillin. Dicloxacillin is used to treat the bacterial infections of the skin, respiratory
tract, and bone. The most important benefit of this medicine in emergency cases is its onset of

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action. The effects of this antibiotic can be seen in 30 minutes of administration. On the other
hand, the cephalexin takes 1 hour to exhibit e its effects on bacterial infection (Practo, 2017).
Another major befits of using this medicine is that its duration of effects. The effects of this
antibiotic last for nearly 6 hours and cephalexin show its beneficial effect for 4 to 5 hours
only (Practo, 2017).
Mode of action of dicloxacillin
The route of administration of this medicine is oral. It enters the bloodstream and
attaches to one or more of the penicillin-binding proteins (PBPs) by inhibiting the synthesis if
bacterial cell wall. It exerts the bacterial autolytic effect by preventing the PBPs related to
the initiation of the bacterial autolytic process (Etebu, & Arikekpar, 2016).
Adverse reaction
1. It may cause shortness of breathing
2. Diarrhea is the common adverse reaction of dicloxacillin which may become severe in
some cases (Etebu, & Arikekpar, 2016).
The treatment process of Mary's wound
The treatment process involves three important steps use of antibiotics, invasive
surgery treatment, and wound care. As discussed above antibiotic treatment can be used to
kill the microorganism from the wound and the antibiotic used in Mary’s case is dicloxacillin.
The time of using antibiotic may be longer in this case as the wound is deep and infected by
Staphylococcus aureus. The antibiotic treatment takes one week to kill the pathogen. If the
wound does not heal well or the microorganism’s growth is not removed that invasive
surgery can be used to clean the wound. The dead or infected tissues present in the wound are
removed by this procedure. The next step is wound care which is the important step after the
antibiotic and surgical treatment. The wounds should be cleaned on a regular basis and

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dressings should be changed (Bullock & Manias, 2017). After removing the dressing or old
bandage the wound should be cleaned and the new bandage is applied to the wound. In some
surgical wounds VAC (vacuum-assisted closure) dressing can be used which increases the
flow of blood to the wound (Lee, & Bishop, 2016)

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References
Anderson, D. J., & Kaye, K. S. (2009). Staphylococcal surgical site infections. Infectious
disease clinics of North America, 23(1), 53-72.
Bessa, L. J., Fazii, P., Di Giulio, M., & Cellini, L. (2015). Bacterial isolates from infected
wounds and their antibiotic susceptibility pattern: some remarks about wound
infection. International wound journal, 12(1), 47-52.
Bullock, S., & Manias, E. (2017). Fundamentals of Pharmacology (8th ed.). Frenchs Forest,
Australia: Pearson Australia
Craft, J., & Gordon, C. (Eds.). (2015). Understanding pathophysiology (Australian and New
Zealand education). Retrieved from:
https://www.elsevierhealth.com.au/understanding-pathophysiology-anz-adaptation-
9780729541602.html
Etebu, E., & Arikekpar, I. (2016). Antibiotics: classification and mechanisms of action with
the emphasis on molecular perspectives. International Journal of Applied Microbial
Biotechnol Res, 4, 90-101.
Koutoukidis, G., Stainton, K., & Hughson, J. (2016). Tabbner's Nursing Care: theory and
practice. (7th ed.). Chatswood, NSW: Elsevier Health Sciences.
Lee, G., & Bishop, P. (Eds.). (2016). Microbiology and infection control for health
professionals. (6th ed.). Melbourne, Victoria: Pearson Australia.
Marieb, E.N., & Hoehn, K. (2016). Human anatomy & physiology (10th ed.). Harlow, United
Kingdom: Pearson Education.

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Practo (2017). Cephalexin. Retrieved from:
https://www.practo.com/medicine-info/cephalexin-250-mg-tablet-28038
Reichman, D. E., & Greenberg, J. A. (2009). Reducing surgical site infections: a
review. Reviews in Obstetrics and Gynecology, 2(4), 212.
Sukumaran, V., & Senanayake, S. (2016). Bacterial skin and soft tissue infections. Australian
Prescriber, 39(5), 159.