The human epidermis is a multilayer interface between the body and the environment. The skin is a complex structural, microbial and immunological barrier organ made of a symbiotic relationship between non-pathologic microbial communities (microbiom) and host tissue via signals provided by the innate and the adaptive immune systems. The structural and functional integrity of the skin barrier is the critical first line of defense against invasion by pathogen bacteria. The normal skin barrier and the microbiome act like a shield. This balance is continuously affected by host and environmental factors. The macerated skin surface have a destroyed epidermal barrier, making the skin susceptible to infections and biofilm development. The biofilm is a thick layer of pathogen microorganisms that have aggregated to form a colony. The colony is embedded in a biofilm matrix consists of extracellular desoxyribonucleic acid, complex polysaccharide polymers, lipoproteins, which minimizes sensitivity to antibiotics.
Healthcare workers’ good compliance with hand hygiene is the most important intervention in the infection control. The best approach to treat biofilms in chronic wounds includes
following antibiotic stewardship, wound cleansing, frequent debridement, therapy of acute infections and subsequent application of appropriate wound dressings.

Authors performed microbiological culturing of chronic skin infections. 115 bacterial species were identified. Eight-to-ten species comprised about two-thirds of the pathogens.
These frequently isolated bacteria often proved to be multidrug-resistant. Biofilms formed on the surface of the infected area pose a challenge not only for microbiological diagnosis but therapy. These biofilms include multiple species, and consequently, chronic skin infections are often polymicrobial.
Authors review relevant information related to sampling, discuss the antibiotic resistance profiles of the most common species and local- and systemic therapeautic options.

Inappropriate use of antibiotics poses a serious risk to patient safety. Unnecessary or ineffective antibiotic treatment can potentially lead to significant side effects and also promote the development of antibiotic-resistant bacteria thereby endangering the overall therapeutic efficacy and applicability of the antibiotics. Inadequate antibiotic use at all levels of medical care and the development of antimicrobial resistance is therefore a global public health problem, to avoid it institutional antibiotic stewardship program is needed. The basic principle of antibiotic stewardship is the right treatment, at the right time, at the right duration and in the right dose. The most important goal is ”the careful regulation of antibiotic treatment”, that is while healing the patients, preserving the effectiveness of the antibiotics, preventing the spread of resistant pathogens, and reducing the cost of the health care.

In Hungary, the incidence of major lower extremity amputations is currently several times higher than the European average. The amputation occurs at the youngest age, and hospital mortality is high. The rate of diabetic patients among amputees is approximately 55%. In most of the diabetic patients, amputation is preceeded by neuropathy associated unnoticed foot injury, with foot ulcer and infection, resulting in emergency (typical foot attack). At a higher proportion of the patients, major amputation can be avoided by the proper use of antibiotics, by timely and correctly performed surgery and offloading. In the minority of the cases, revascularisation is also necessary for limb’s salvage. Effective treatment of diabetic foot infection is based on early detection of the infection and on patient care, with appropriate personal and technical conditions. In this article, we summarise host and pathogen-related factors in the development of diabetic foot infection, work up, and classification of diabetic foot infection and the stepwise approach to the multidisciplinary treatment.

Infection is a common complication of chronic wounds, it leads to delay in wound healing. Because of their morbidity, mortality and cost, these issues are a significant patient safety
concern in hospitals and long-term care facilities. Several studies have shown that infection prevention and control programs can decrease healthcare-associated infection and chronic wound infection rates. This paper shows the basically preventive strategies which can be used in chronic wound care.

Interdigital bacterial intertrigo is not a rare disorder. This condition can be confused with interdigital tinea infection or contact dermatitis. The macerated eruption is unresponsive
to treatment with antifungal or anti-inflammatory agents. Proper identification of bacterial infection is critical for early antibiotic theapy. Pseudomonas aeruginosa and Enterococcus sp. were the most commonly isolated organisms.
The infection was effectively treated with Ciprofloxacin.

Lymphedema is a chronic swelling that develops when the lymph is not moving properly as a result of damage to the lymph nodes or/and lymph vessels. In the severe cases
lymphorrhoea begins, inflammatory wounds develop and the skin around the wound is macerated. Periulceral skin maceration of lymphedema patients is a largely under-recognized problem and one of the causes of delayed wound healing.
The superabsorbent dressing seems to reduce complications associated with exudate production, and damage of physiological microbiom. Superabsorbent dressing stimulates
wound healing and increases patients’ comfort. It may also save time and costs for care.