6
Treatment
Figure 2. Wound Infection Algorithm
Fever in first 48 hours
(and up to 4 days)
Fever >4 days after
operation
Unlikely to represent
wound infection
No systemic
illness
Systemic
illness
No wound
infection
Wound drainage or
marked local signs
of inflammation
NONE
YES
Gram stain to rule
out streptococci and
clostridia
Seek other
resources of
fever
Either Found
NONE
Seek other
sources of
fever
Open wound,
debride, start
penicillin and
clindamycin
a
For patients with type 1 (anaphylaxis or hives) allerg y to β-lactam antibiotics. If Gram stain
not available, open and debride if purulent drainage present. Where the rate of infection with
MRSA is high, consider vancomycin, daptomycin, or linezolid, pending results of culture and
susceptibility tests.
Adapted and modified with permission from Dellinger EP.
Erythema
and/or
induration
Wound
normal to
exam
Open wound
Seek other
sources of fever
• Temp <38ºC
• WBC <12,000
• Erythema <5 cm
• Temp >38ºC
• WBC >12,000
• Erythema >5 cm
from incision
with induration
or any necrosis
Dressing
changes, no
antibiotics
Begin antibiotics
and dressing
changes
Clean wound,
trunk, head,
neck, extremity
Wound of perineum
or operation on GI
tract or female genital
tract
Start cefazolin or
vancomycin
a
until
MRSA ruled out
Start
cephalosporin+metronidazole
or
levofloxacin+metronidazole
or carbapenem
a
Operation
Observe
