Quel dispositif médical et/ou quel médicament local choisir pour un patient porteur d’une escarre infectée en 2012 ? Vers l’élaboration de recommandations françaises pour la pratique clinique

Introduction. – Taking care of a patient with an infected pressure sore necessitates a diagnosis allowing for a suitable treatment strategy. Aims. – To choose the dressings and topical antimicrobial agents that can be used as of 2012 in treatment of an infected pressure sore. Methods. – A systematic review of the literature with queries to the databases Pascal Biomed, PubMed and Cochrane Library from 2000 through 2010. Results. – Diagnosis of local infection is essentially clinical. It is subsequently difficult to destroy and/or permeabilize biofilm by means of mechanical wound debridement. Application of an antimicrobial product and a disinfectant solution are of utmost importance in this respect. Discussion. – The studies do not demonstrate that one topical product is better than another in wound cleaning. The papers recommending antimicrobial topics lead to the conclusion that they may be interesting, but show little clinical evidence of their beneficial effects. Dressings including silver, iodine, polyhexamethylene biguanide (PHMB) and negative pressure wound therapy could likewise be of interest, but once again, existing studies present only a low level of evidence (Grade C). Conclusion. – Local antimicrobial treatment can be used when there are signs of local infection (Grade C). Systemic antibiotic treatment is to be used when there are general medical signs of infection (Grade B). # 2012 Published by Elsevier Masson SAS.