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Surface bacteriology of venous leg ulcers and healing outcome
  1. Keith Moore1,
  2. Val Hall2,
  3. Alan Paull2,
  4. Trefor Morris2,
  5. Sarah Brown3,4,
  6. Dorothy McCulloch3,
  7. Mark C Richardson3,
  8. Keith G Harding1
  1. 1Department of Wound Healing, Cardiff University, Cardiff, UK
  2. 2NPHS Microbiology Cardiff, University Hospital of Wales, Cardiff, UK
  3. 3Smith & Nephew Medical Ltd, Hull, UK
  4. 4Clinical Trials Research Unit, University of Leeds, Leeds, UK
  1. Correspondence to Dr K Moore, Department of Wound Healing, Cardiff University, School of Medicine, Upper Ground Floor, Heath Park, Cardiff CF14 4XN, UK; keith{at}xyres.co.uk

Abstract

Aim Bacteria can be cultured from all venous leg ulcers (VLUs) regardless of healing status, and the significance of a positive swab result in non-clinically infected ulcers is unknown. The aim of this study was to characterise the bacteriological flora of VLUs by routine culture to determine whether the data generated had prognostic value.

Methods The ulcers of 178 patients were sampled weekly for 12 weeks and healing outcome monitored while the limb was treated with graduated compression. Wound bacteriology was assessed using culture methodology standardised to ensure data reproducibility.

Results 153 individual bacterial species were identified. The species most frequently found were Staphylococcus aureus (64.3% of assessments), Corynebacterium striatum (60.6%), Pseudomonas aeruginosa (32.6%), Helcococcus kunzii (22.0%), Finegoldia magna (21.4%) and Proteus mirabilis (16.1%). No single species or the presence of anaerobes and increasing diversity of bacterial species, previously thought to be predictive of impaired healing, was shown to be associated with healing outcome. The presence of C striatum was associated with healing outcome but not after adjusting for the known prognostic factors of wound area and duration.

Conclusion Routine bacteriological culture analysis of the VLU wound surface may be used to identify diverse flora in all ulcers. However, the data generated are of no additional value as a prognostic indicator of healing outcome. The presence of C striatum may represent colonisation of non-healing VLU by normal skin flora.

  • Venous leg ulcer
  • chronic wound
  • bacteriology
  • prognosis
  • Corynebacterium striatum
  • anaerobes

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Footnotes

  • Funding This study was funded by a grant from Smith & Nephew Medical.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Bro Taf Local Research Ethics Committee, Cardiff and the Gloucester Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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