Bacterial colonization of chronic leg ulcers: current results compared with data 5 years ago in a specialized dermatology department (original) (raw)
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Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2014
Chronic wounds are colonized by many different bacteria. We analyzed microbiological swabs from chronic leg ulcers from 2012/2013 and matched the results with those from 2002/2003 and 2007/2008 from the same institution. Results from 100 patients from our specialized wound care center were evaluated retrospectively. The etiologies were broadly variable with chronic venous insufficiency being the most common. As the most common bacterium Staphylococcus aureus was found in 53% of patients; 9% of patients were positive for methicillin-resistant S. aureus (MRSA). Pseudomonas aeruginosa was detected in 25% of patients. Different fecal bacteria and Enterobacteriaceae were found in 49% of the patients; 11% of the swabs were sterile. The detection rate for S. aureus has regressed by 17.1% over the past decade and in the case of MRSA by 12.5%. In contrast, colonization with gram-negative bacteria species significantly increased by 11.7%. This tendency was also seen in 2007/2008, but with a h...
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2013
Background: In almost every chronic wound different bacteria species can be detected. Patients and methods: Retrospective, multicenter evaluation of bacterial swab results from 2010 and 2011 in patients with chronic leg ulcer treated in 10 dermatologic wound care centers from 5 regions in Germany. Results: Data of 970 patients were analyzed. Staphylococcus aureus was detected in 47.6 % of the patients, 8.6 % of these were methicillin-resistant (MRSA). Pseudomonas aeruginosa was found in 31.1 %, enterobacteria in 28.6 % and Proteus mirabilis in 13.7 % of the patients. The regional comparison showed a significant south-north gradient for S. aureus, P. aeruginosa, and enterobacteria. Moreover, a highly significant west-east gradient for MRSA was found with detection rates of 13.5 % in the west to 4.0 % in the east. Furthermore, nationally there was a significant negative correlation between S. aureus and P. aeruginosa or P. mirabilis, respectively, as well as a positive correlation of P. aeruginosa with respect to wound size and duration. In addition to climatic and therapeutic conditions, different regional health care structures are discussed as potentially relevant reasons for these significantly different regional detection rates. Conclusions: Our data show the regional variability of the spectrum of currently detected bacteria in patients with chronic leg ulcers in Germany.
Bacteriological pattern of wound swab isolates in patients with chronic leg ulcer
International Journal of Health Research, 2010
and full-text of published articles. The journal is devoted to the promotion of health sciences and related disciplines (including medicine, pharmacy, nursing, biotechnology, cell and molecular biology, and related engineering fields). It seeks particularly (but not exclusively) to encourage multidisciplinary research and collaboration among scientists, the industry and the healthcare professionals. It will also provide an international forum for the communication and evaluation of data, methods and findings in health sciences and related disciplines. The journal welcomes original research papers, reviews and case reports on current topics of special interest and relevance. All manuscripts will be subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication) will be published without delay. The maximum length of manuscripts should normally be 10,000 words (20 single-spaced typewritten pages) for review, 6,000 words for research articles, 3,000 for technical notes, case reports, commentaries and short communications.
Microbiological profile of leg ulcer infections: review study
Revista brasileira de enfermagem, 2021
OBJECTIVES to analyze the microbiological profile of leg ulcers of patients treated at outpatient clinics and hospitals regarding the type of microorganism, microbiological selection of antibiotics, and techniques for the collection of culture material. METHODS literature review performed on LILACS, IBECS, MEDLINE, and CINAHL databases, resulting in a descriptive analysis of 27 studies. RESULTS 35.7% of the studies occurred in an outpatient care scenario; and 64.2% in hospitals. There was a predominance of swab (100%) in outpatient care and biopsy (55.5%) in the hospital. Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were more common at both levels of assistance. Methicillin-resistant Staphylococcus aureus was isolated in both. CONCLUSIONS the microbiological profile of infections was similar, with the presence of resistant bacteria in both environments. This fact causes concern and raises the need for research to elucidate it. The studies did not compare the e...
Chronic wound infections: the role of Pseudomonas aeruginosa and Staphylococcus aureus
Expert review of anti-infective therapy, 2015
Chronic leg ulcers affect 1-2% of the general population and are related to increased morbidity and health costs. Staphylococcus aureus and Pseudomonas aeruginosa are the most common bacteria isolated from chronic wounds. They can express virulence factors and surface proteins affecting wound healing. The co-infection of S. aureus and P. aeruginosa is more virulent than single infection. In particular, S. aureus and P. aeruginosa have both intrinsic and acquired antibiotic resistance, making clinical management of infection a real challenge, particularly in patients with comorbidity. Therefore, a correct and prompt diagnosis of chronic wound infection requires a detailed knowledge of skin bacterial flora. This is a necessary prerequisite for tailored pharmacological treatment, improving symptoms, and reducing side effects and antibiotic resistance.
The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice
International Wound Journal, 2019
This literature review aimed to provide a narrative review of evidence on validity of clinical and microbial indicators of infection and to gain insight of the diagnosis of infection in chronic leg ulcers. A search was conducted in Cinahl, Medline, the Cochrane Library databases, Embase, Web of Science, ScienceDirect, Pubmed, PsycINFO, ProQuest dissertations and Google Scholar from Januray 1990 to July 2017. The inclusion criteria were original studies, systematic reviews and consensus documents focused on "infection" in chronic leg ulcers, English language, clinical and community settings, and human. The reviewed studies were inconsistent in criteria for infection between investigated wound types and lack of specificity regarding wound types. There were few studies investigating the criteria for diagnosis of infection in leg ulcers. The identification of leg ulcer infection still remains problematic and relies on out-of-date and not uniform evidence. Literature in this area was mostly limited to level III and IV evidence based on The Australian National Health and Medical Research Council Levels of Evidence, or expert opinion. This literature review revealed seven clinical signs and symptoms that could be diagnostic for infection in chronic leg ulcers, including: new, increased or altered ulcer pain; malodour; increased ulcer area; wound breakdown, delayed or non-healing; erythema and increased local temperature, while the microbial indicators used to diagnose infected leg ulcers were varied and regarded as less important.
BMC Research Notes, 2014
Background: Infections, trauma, malignances and poorly controlled diabetes are common causes of chronic lower limb ulcerations in developing countries. Infected wound with multi-drug resistant bacteria usually are associated with increased morbidity and mortality. We report the distribution of bacteria pathogens colonizing the chronic lower limb ulcers and their drug susceptibility pattern from Bugando Medical Centre (BMC) a tertiary hospital in Tanzania. Findings: Three hundred non-repetitive wound swabs were aseptically collected from 300 patients with chronic lower limb ulcers using sterile swabs and processed following standard operative procedures. Isolates were identified using in house biochemical testing and in case of ambiguous confirmation was done using API 20NE and API 20E. Susceptibility was determined using disc diffusion test following clinical laboratory standard Institute guidelines (CLSI). Of 300 swabs from patients with chronic lower limbs ulcers, 201 (67.7%) had positive aerobic culture within 48 hours of incubation. Of 201 isolates, 180(89.6%) were gram-negative bacteria. Out of 180 gram negative bacteria, resistance was detected for ampicillin (95%, n = 171), amoxicillin/clavulanate (83.9%, n = 151), trimethoprim-sulphamethoxazole (78.9%, n = 142), ceftriaxone (46.7%, n = 84), ceftazidime (45.6%, n = 82), gentamicin (39.4%, n = 71), ciprofloxacin (17.8%, n = 32) and meropenem 28(15.6%, n = 25). A total of 41 (35%) of enterobacteriaceae were found to be extended spectrum beta-lactamases (ESBL) producers while of 18 Staphylococcus aureus, 8(44.4%) were found to be methicillin resistant Staphylococcus aureus (MRSA).
The bacteriology of chronic venous leg ulcer examined by culture-independent molecular methods
Wound Repair and Regeneration, 2010
The bacterial microbiota plays an important role in the prolonged healing of chronic venous leg ulcers. The present study compared the bacterial diversity within ulcer material from 14 skin graft operations of chronic venous leg ulcers using culture-based methods and molecular biological methods, such as 16S rRNA gene sequencing, fingerprinting, quantitative polymerase chain reaction, and fluorescence in situ hybridization. Each wound contained an average of 5.4 species but the actual species varied between wounds. The diversity determined by culture-based methods and the molecular biological methods was different. All the wounds contained Staphylococcus aureus, whereas Pseudomonas aeruginosa was in six out of 14 wounds. Molecular methods detected anaerobic pathogens in four ulcers that were not detected with anaerobic culture methods. Quantitative polymerase chain reaction was used to compare the abundance of S. aureus and P. aeruginosa at different locations in the ulcers and their numbers varied greatly between samples taken at different locations in the same ulcer. This should be considered when ulcers are investigated in routine clinical care. The differences between the results obtained with culture-based and molecular-based approaches demonstrate that the use of one approach alone is not able to identify all of the bacteria present in the wounds.
Romanian Journal of Morphology and Embryology Revue Roumaine De Morphologie Et Embryologie, 2014
Chronic wounds represent an important burden on the healthcare system, requiring frequent hospitalizations and expensive treatments. It is now recognized that a primary factor contributing to a non-healing trajectory and a low therapeutic response is the biofilm infection. The purpose of this study was to identify the bacterial isolates collected from chronic skin wounds of hospitalized patients and to evaluate their antimicrobial susceptibility profiles, virulence factors, as well as the ability to develop biofilms in vitro. A number of 44 wound samples were collected from 39 patients. The isolated strains belonged to seven different microbial species, i.e.: Staphylococcus aureus (32 strains), followed by Pseudomonas aeruginosa (4), Escherichia coli (3), Klebsiella pneumoniae (2), Proteus mirabilis (1), Citrobacter freundii (1), group G β-hemolytic streptococci (1). In comparison to the other isolates, P. aeruginosa strains exhibited the highest capacity to develop complex biofilm structures in vitro, followed by S. aureus, with insignificant differences between MRSA and non-methicillin resistant isolates. The Enterobacteriaceae strains expressed less virulent phenotypes, lower adherence to epithelial cells and biofilm forming capacity, but also significant resistance phenotypes with a potential of unfavorable epidemiological outcome. The isolation of MRSA, ESBL-producing microorganisms and multiple antibiotic resistant P. aeruginosa suggests the potential risk of nosocomial spread and the potential severe outcome in case of bacteremia and sepsis. This study represents an important step in elucidating the host-wound microbiome interaction, by describing various resistance and virulence threats of microorganisms colonizing and/or infecting the chronic wounds. However, in order to establish a statistical relevant correlation, larger studies are needed.