Microbiological profile of leg ulcer infections: review study

Garcia, Taysa de Fátima; Borges, Eline Lima; Junho, Thaisa Oliveira de Castro; Spira, Josimare Aparecida Otoni

doi:10.1590/0034-7167-2019-0763

Cited by 12 publications

(12 citation statements)

References 41 publications

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“…Gram-positives were 48.3%, with S. aureus emerging as the dominant species. These data are in agreement with other reports from patients with VUs showing comparable microbial distribution [ 31 , 32 , 33 ]. Historically, culture-based methods represented the gold standard for microbial isolation and ulcer identification [ 34 ].…”

Section: Discussionsupporting

confidence: 94%

Homocysteine and Inflammatory Cytokines in the Clinical Assessment of Infection in Venous Leg Ulcers

et al. 2022

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Inflammation and biofilm-associated infection are common in chronic venous leg ulcers (VU), causing deep pain and delayed healing. Albeit important, clinical markers and laboratory parameters for identifying and monitoring persistent VU infections are limited. This study analyzed 101 patients with infected (IVU) and noninfected VUs (NVU). Clinical data were collected in both groups. The serum homocysteine (Hcys) and inflammatory cytokines from the wound fluid were measured. In addition, microbial identification, antibiotic susceptibility, and biofilm production were examined. IVU were 56 (55.4%) while NVU were 45 (44.5%). IVUs showed a significant increase in the wound’s size and depth compared to NVUs. In addition, significantly higher levels of interleukin (IL)-6, IL-10, IL17A, and tumor necrosis factor-alpha (TNF-α) were found in patients with IVUs compared to those with NVUs. Notably, hyperhomocysteinemia (HHcy) was significantly more common in patients with IVUs than NVUs. A total of 89 different pathogens were identified from 56 IVUs. Gram-negative bacteria were 51.7%, while the Gram-positives were 48.3%. At the species level, Staphylococcus aureus was the most common isolate (43.8%), followed by Pseudomonas aeruginosa (18.0%). Multidrug-resistant organisms (MDROs) accounted for 25.8% of the total isolates. Strong biofilm producers (SBPs) (70.8%) were significantly more abundant than weak biofilm producers (WBP) (29.2%) in IVUs. SBPs were present in 97.7% of the IVUs as single or multispecies infections. Specifically, SBPs were 94.9% for S. aureus, 87.5% for P. aeruginosa, and 28.6% for Escherichia coli. In IVU, the tissue microenvironment and biofilm production can support chronic microbial persistence and a most severe clinical outcome even in the presence of an intense immune response, as shown by the high levels of inflammatory molecules. The measurement of local cytokines in combination with systemic homocysteine may offer a novel set of biomarkers for the clinical assessment of IVUs caused by biofilm-producing bacteria.

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Section: Discussionsupporting

confidence: 94%

Homocysteine and Inflammatory Cytokines in the Clinical Assessment of Infection in Venous Leg Ulcers

et al. 2022

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“…Less frequently, samples of the following bacteria are isolated: Proteus mirabilis , Klebsiella pneumoniae , Streptococcus agalactiae , Enterobacter cloacae , Proteus vulgaris , Acinetobacter baumanni , Morganella morganii , Klebsiella oxytoca , Citrobacter koseri , Citrobacter freundii , Coagulase-negative Staphylococcus and Stenotrophomonas maltophilia . Non-healing ulcers and ulcers with a longer duration and larger wound surface have a higher microbiological diversity [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Microbiological Status of Venous Leg Ulcers and Its Predictors: A Single-Center Cross-Sectional Study

Cwajda‐Białasik

Mościcka

Jawień

et al. 2021

IJERPH

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Venous leg ulcers are frequently colonized by microbes. This can be particularly devastating if the ulcer is infected with alert pathogens, i.e., highly virulent microorganisms with well-developed mechanisms of antibiotic resistance. We analyzed the microbiological status of venous leg ulcers and identified the clinicodemographic predictors of culture-positive ulcers, especially in ulcers with colonization by alert pathogens. Methods: This study included 754 patients with chronic venous leg ulcers. Material for microbiological analysis was collected by swabbing only from patients who did not receive any antibiotic treatment. Results: A total of 636 (84.3%) patients presented with culture-positive ulcers. Alert pathogens, primarily Pseudomonas aeruginosa, were detected in 28.6% of the positive cultures. In a logistic regression model, culture-positive ulcers were predicted independently by age > 65 years, current ulcer duration > 12 months, and ulceration area greater than 8.25 cm2. Two of these factors, duration of current ulcer > 12 months and ulceration area > 8.25 cm2, were also identified as the independent predictors of colonization by alert pathogens. Conclusions: Colonization/infection is particularly likely in older persons with chronic and/or large ulcers. Concomitant atherosclerosis was an independent predictor of culture-negative ulcers.

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“…Increased bacterial load is considered one of the causes of chronicity of skin lesions, especially when biofilm formation occurs 8 , 9 , 11 , 24 , 32 , 33 . In clinical practice, the delay in the wound healing process with critical colonization or recurrent infection is also perceived in patients with wounds of various etiologies 34 , a situation that can be aggravated by the inefficient eradication of infectious and opportunistic pathogens 35 , such as bacterial biofilms.…”

Section: Discussionmentioning

confidence: 99%

Biofilm model on mice skin wounds

et al. 2022

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Purpose: To evaluate a biofilm model of Pseudomonas aeruginosa in excisional cutaneous wound in mice. Methods: Preclinical, translational study conducted with 64 C57BL/6 mice randomly assigned to control and intervention groups. Evaluation was on days D0, D3, D5, D7 and D10 of wound making. The profile of biofilm formation and induction was evaluated using wound closure kinetics, quantitative culture, and evaluation of wounds using transmission electron microscopy (TEM). Clinical evaluation was performed by liver tissue culture, weight variation, and quantification of leukocytes in peripheral blood. Analyses were performed with GraphPad Prism software. Results: Bacterial load for induction of infection with P. aeruginosa and survival of animals was 10 4 UFC·mL -1 . In D5 (p < 0.0001) and D7 (p < 0.01), animals in the intervention group showed a delay in the healing process and had their wounds covered by necrotic tissue until D10. Statistical differences were observed in wound cultures and weight at D5 and D7 (p < 0.01). Liver cultures and leukocyte quantification showed no statistical differences. No bacteria in planktonic or biofilm form were identified by TEM. Conclusions: The findings raise questions about the understanding of the ease of formation and high occurrence of biofilm in chronic wounds.

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Microbiological profile of leg ulcer infections: review study

Cited by 12 publications

References 41 publications

Homocysteine and Inflammatory Cytokines in the Clinical Assessment of Infection in Venous Leg Ulcers

Homocysteine and Inflammatory Cytokines in the Clinical Assessment of Infection in Venous Leg Ulcers

Microbiological Status of Venous Leg Ulcers and Its Predictors: A Single-Center Cross-Sectional Study

Biofilm model on mice skin wounds

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