9: Management of Limb Cellulitis

• We recommend that cellulitis (inflammation and infection of the skin and subcutaneous tissue) surrounding the venous leg ulcer be treated with systemic gram-positive antibiotics (Grade 1, Level B).

10: Wound Colonization and Bacterial Biofilms

• We suggest against systemic antimicrobial treatment of venous leg ulcer colonization or biofilm without clinical evidence of infection (Grade 2, Level C).

11: Treatment of Wound Infection

• We suggest that venous leg ulcers with >1 X 106 CFU/g of tissue and clinical evidence of infection be treated with antimicrobial therapy (Grade 2, Level C).
• We suggest antimicrobial therapy for virulent or difficult to eradicate bacteria (such as beta-hemolytic streptococci, pseudomonas, and resistant staphylococcal species) at lower levels of colony-forming units per gram of tissue (Grade 2, Level C).
• We suggest a combination of mechanical disruption and antibiotic therapy as most likely to be successful in eradicating venous leg ulcer infection (Grade 2, Level C).

12: Systemic Antibiotics

• We recommend that venous leg ulcers with clinical evidence of infection be treated with systemic antibiotics guided by sensitivities performed on wound culture (Grade 1, Level C).
• Oral antibiotics are preferred initially, and the duration of antibiotic therapy should be limited to 2 weeks unless persistent evidence of wound infection is present (Grade 1, Level C).

13: Topical Antibiotics for Infected Wounds

• We suggest against use of topical antimicrobial agents for the treatment of infected venous leg ulcers (Grade 2, Level C).