Despite the continued attention given to this problem, therefore, there is a critical gap in the knowledge base that centers on the value of wound culture findings in predicting clinical outcomes. The problem is that many studies on chronic wound infection have used variable definitions to determine wound infection, variable methods of wound sampling, and variable laboratory procedures for processing wound cultures (Bowler, 1998). The reiteration of these issues underscores the continued frustration felt by clinicians and experts in screening chronic wounds for localized infection. Although a few of these have provided data to advance the knowledge base in this area, most address the problems associated with the uncertainty regarding the definition of infection, the issues surrounding wound cultures, rationales supporting best culturing techniques, and the role of clinical signs of infection.
During the past 10 years, 50 papers in the nursing and medical literature were devoted specifically to identifying and diagnosing infection in the chronic wound. Nonetheless, the identification and diagnosis of DFU infection, like chronic wound infection in general, remains a complex and unsolved problem (Bowler, 2003). For example, 14–24% of persons with DFUs will have an amputation ( ADA, 1999), and complications associated with foot ulcers account for 20–25% of all hospital days for persons with diabetes (Reiber, 1995). Outcomes associated with infection-related complications among persons with DFUs are striking. Persons with diabetes are at higher risk for developing infections (Grossi et al., 1991 Josephs et al., 1993 Reiber et al., 2001 Wymenga et al., 1992) due to the effects of hyperglycemia on leukocyte function (Pecoraro & Chen, 1987). Approximately 15–20% of persons with diabetes will develop a DFU in their lifetime ( American Diabetes Association, 1999 Boulton et al., 1999). The prevalence of diabetes is 6.3% in the general population, 8.7 among persons 20 years of age and older (Center for Disease Control and Prevention, 2003), and 17% among veterans enrolled in Veterans Health Administration (VHA) (Reiber et al., 2001).
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