What is the treatment for an umbilical smell with drainage?

Treatment for Umbilical Smell with Drainage

For an umbilical area with foul smell and drainage, cleanse the area with an antiseptic solution and seek medical evaluation, as this likely represents an infection requiring appropriate antimicrobial therapy based on the specific pathogen involved. 1, 2

Assessment and Diagnosis

• Umbilical discharge with odor often indicates infection, which may be bacterial colonization of the umbilical stump or surrounding tissues 1
• Common pathogens include Staphylococcus aureus, group A and B Streptococci, and Gram-negative bacilli such as Escherichia coli, Klebsiella species, and Pseudomonas species 1
• Recent research has found that odor is associated with certain anaerobic bacteria in the umbilicus, including Mobiluncus, Arcanobacterium, and Peptoniphilus 2
• Assess for signs of more serious infection such as periumbilical erythema, tenderness, purulent discharge, or systemic signs of infection 1

Treatment Approach

Immediate Management

• Cleanse the umbilical area with an antiseptic solution such as povidone-iodine (avoid tincture of iodine in neonates due to potential thyroid effects) 1
• Do not apply topical antibiotic ointments or creams to the umbilical area as they may promote fungal infections and antimicrobial resistance 1
• For mild cases with only discharge and odor without significant surrounding inflammation, daily cleaning with antiseptic solution may be sufficient 1, 3

For Umbilical Granuloma (Common Cause of Persistent Drainage)

• If a small, reddish, moist tissue mass is visible at the umbilicus, this likely represents an umbilical granuloma 4
• Treatment options include:
  • Application of silver nitrate (traditional approach) 4
  • Surgical excision with application of absorbable hemostatic materials (more definitive approach that may prevent recurrence) 4

For Moderate to Severe Infections

• For cases with significant inflammation, spreading cellulitis, or systemic symptoms, systemic antibiotics are indicated 1
• Initial empiric therapy should cover Staphylococcus aureus and Streptococcus species 1
• Adjust antibiotic therapy based on culture results if available 3

For Persistent Cases

• Evaluate for underlying conditions such as:
  • Umbilical pilonidal sinus (hair tuft in the infected umbilicus) 3
  • Foreign material in the umbilicus 3
  • Urachal remnant or other embryologic anomalies 5
• Surgical consultation may be necessary for persistent cases not responding to conservative management 3

Special Considerations

For Neonates

• In newborns, the WHO recommends:
  • For hospital births or in settings with low neonatal mortality: dry cord care 1
  • For home births or in settings with high neonatal mortality: application of 4% chlorhexidine solution or gel to the umbilical cord stump within 24 hours after birth 1
• Remove umbilical catheters immediately if any signs of catheter-related bloodstream infection (CRBSI) are present 1, 6

For Adults

• Conservative approach is generally recommended for most cases of umbilical discharge 3
• Surgical excision should be reserved for selected cases that don't respond to conservative management 3
• Laparoscopic evaluation may be necessary for persistent unexplained cases to rule out intra-abdominal pathology 7

Prevention

• Maintain good umbilical hygiene with regular cleaning 2
• Ensure the umbilical area is thoroughly dried after bathing 1
• Avoid tight clothing or belts that may irritate the umbilical area 3