Goal: If a wound develops signs of infection (e.g., increasing pain, erythema, purulent drainage) or the patient becomes systemically ill (e.g., fever, tachycardia, hypotension, lethargy, decreased mental status), wound infection must be identified and treated. Treat infected wounds with a combination of local wound care and systemic antibiotics.

- Remove all dressings and inspect wound.
- Wounds that have been closed must be reopened.
- Repeat wound debridement to drain pus and remove all dead, infected tissue. If necessary, extend the wound with an incision in the long axis of the extremity.
- Worst-case scenario may require amputation of an extremity to control life-threatening infection.
- Increase the frequency of dressing changes to once or twice daily.
- Continue antibiotics for 7–10 days, moxifloxacin 400mg PO daily, levofloxacin 750mg PO daily, or ertapenam 1g IV daily, or alternative broad-spectrum antibiotic as available (if possible, change antibiotic from prevention regimen).
- Wounds with known or suspected infections can be treated using Dakin’s solution (dilute bleach) for irrigation and wet-to-dry dressing. This can be an effective adjunct, particularly for suspected fungal and Pseudomonal infections.3,15

Daily sugar or honey dressings for infected wounds may successfully treat infection in very austere settings.12 This involves irrigating the wound with saline or the cleanest water available and then filling it with sugar or honey, which is left in place under a dry dressing, repeating every 24 hours.

Severe wound infection is life threatening and may require aggressive debridement, up to and including amputation. Evacuate patient. If evacuation is not possible, obtain telemedicine consultation and initiate infection treatments above.