This study investigated the bacterial profile of leg ulcers in 52 patients attending the Fremantle Hospital leg ulcer clinic. The aim was to identify whether the presence of specific bacterial groups delays healing, whether the bacterial flora changes as ulcers heal and, if so, whether these changes influence healing. The results show that the presence of any one specific bacterial group did not appear to delay healing, although the presence of four or more bacterial groups was associated with delayed healing. This was found to be statistically significant. It was noted that the bacterial flora does change as ulcers heal and that these changes were not related to changes in healing, with the exception of skin flora.

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Aims/hypothesis: We examined the prognosis of well-characterised community-based diabetic patients with asymptomatic bacteriuria (ASB). Methods: We studied 496 adults with type 1 or 2 diabetes participating in a prospective observational study. In addition to detailed clinical and laboratory data, a single mid-stream urine sample was taken for aerobic culture and antibiotic-sensitivity testing. ASB was defined as ≥10 5 colony-forming units/ml of one or two organisms without symptoms of urinary infection. Patients were followed for 2.9±0.6 years for hospital admission for/with urosepsis or death. Results: Thirty-six patients (7.3%) had ASB, comprising 33 females (14.4% of all females) and three males (1.1% of all males). Only female sex predicted ASB amongst a range of variables including indices of metabolic control. Twentynine patients (5.8%) were subsequently hospitalised with urosepsis. Of these, urosepsis was the principal diagnosis in 12 (41%). In a Cox proportional hazards model, ASB was associated with an increased risk of hospitalisation for urosepsis as principal diagnosis (hazard ratio [95% CI] 4.4 [1.2-16.5]; p=0.004). ASB did not predict the combined endpoint of hospitalisation with urosepsis as principal or secondary diagnosis (2.3 [0.8-6.7]; p=0.12), or of non-urinary sepsis as principal (n=12) or principal/secondary (n=28) diagnosis (p>0.3). Conclusions/interpretation: ASB identifies diabetic patients who are at significantly increased risk of subsequent urosepsis requiring hospitalisation. Further large-scale studies are needed to establish the cost-effectiveness of screening for, and pre-emptive treatment of ASB, especially in females.

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Pre-mixed amino acid and dextrose solutions usedfor parenteral nutrition had additions made to them at a ward level by medical officers. Samples of the solutions of the study group and a control group were taken at six hours and at the end of the infusion time and were analysed microbiologically for growth of microorganisms. No organism was isolated from either group. We conclude that making additions to pre-mixed amino acid/dextrose solutions at the ward level does not constitute a microbiological hazard for the patient.