What is the management of a fungal infection at the site of a sutured laceration?

Management of Fungal Infection at a Sutured Laceration Site

For fungal infections at sutured laceration sites, immediate suture removal plus incision and drainage should be performed, followed by appropriate antifungal therapy and wound care.1

Initial Management

• Remove sutures completely from the infected site to allow proper drainage and treatment access 1
• Perform incision and drainage of any collections to remove infected material 1
• Clean the wound thoroughly with irrigation under pressure to remove debris and reduce microbial load 2
• Obtain appropriate specimens for fungal culture and microscopic examination to identify the causative organism 3

Antimicrobial Therapy

• Apply topical antifungal agents directly to the infected site:

  • For dermatophyte infections: miconazole, clotrimazole, or tolnaftate 3
  • For candidal infections: nystatin or azole antifungals 3

• Consider systemic antifungal therapy for extensive or deep infections:

  • Oral azoles (ketoconazole, itraconazole) for dermatophytes and Candida species 3
  • Duration of therapy typically 1-2 weeks, but may be extended based on clinical response 3

• If bacterial superinfection is suspected (significant erythema extending >5 cm from wound edge, temperature >38.5°C, heart rate >110 beats/minute, or WBC count >12,000/μL), add systemic antibiotics 1

Wound Care

• Apply antimicrobial dressings to the site after cleaning 1
• For persistent infections, consider antimicrobial-impregnated dressings that deliver sustained release to the site 1
• Avoid topical antibiotics as they may contribute to resistance 1
• Keep the wound clean and dry to prevent further fungal proliferation 3, 4

Monitoring and Follow-up

• Evaluate the wound within 48 hours after initial treatment for signs of improvement 2
• Monitor for persistent or worsening signs of infection including:
  • Increasing erythema, pain, swelling, or discharge 1
  • Fever or systemic symptoms 1
• If infection persists despite appropriate topical and systemic therapy, consider:
  • Further debridement of necrotic tissue 5
  • Changing antifungal agent based on culture results 3
  • Extending duration of therapy 1

Prevention of Recurrence

• Address predisposing factors such as excessive moisture, occlusion, or underlying skin conditions 1
• Maintain good personal hygiene in the affected area 3, 4
• Consider antimicrobial-coated sutures (triclosan-impregnated) for high-risk wounds in future procedures to reduce infection risk 1, 6, 7

Special Considerations

• For diabetic patients or immunocompromised individuals, more aggressive management with early systemic therapy may be warranted 1
• Monofilament sutures are preferred over multifilament sutures for future wound closures as they cause less bacterial seeding and may reduce infection risk 1, 6, 8
• For extensive or recurrent infections, consider consultation with infectious disease specialists 1