Bacterial flora of chronic venous leg ulcers: shifts over a two-decade period

Mian Matić; Aleksandra Matić

doi:10.2298/VSP240917085M

Mian Matić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; University Clinical Center of Vojvodina, Clinic of Dermatovenereology Diseases, Novi Sad, Serbia
Aleksandra Matić *University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute for Child and Youth Health Care of Vojvodina, Pediatric Clinic, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP240917085M

Keywords: anti-bacterial agents;, bacterial infections;, drug resistance, bacterial;, gram-negative bacteria;, gram-positive bacteria;, varicose ulcer;, microbiology.

Abstract

Background/Aim. Venous leg ulcers (VLUs) are often colonized by various types of bacteria, which can lead to infection that requires empirical antibiotic therapy. Bacterial types and their antibiotic susceptibility vary widely over time and by geographic location. The aim of the study was to determine the change trends of causative bacteria and antibiotic susceptibility in patients with VLUs over the past two decades. Methods. The study was conducted at a tertiary care dermatovenereology clinic. Data on the microbiological analysis of ulcer swabs from patients with VLUs were collected over two consecutive months at three time points: 2001, 2014, and 2020. Results. The study included 250 patients divided into three groups. The first group (2001) had 111 participants, the second group (2014) had 64, and the third group (2020) had 75 participants. Out of the 250 swabs sent for microbiological testing, only 4 (1.6%) samples yielded negative results. In 2001, the bacteria identified were 31.83% Gram-positive (G+) and 68.13% Gram-negative (G-). In 2014, the ratio between G+ and G- bacteria was 27.18% vs. 72.82%. In 2020, the predominance of G- bacteria was even more pronounced, with 89.86% compared to 10.14% G+ (p < 0.001). In 2001, Pseudomonas (P.) aeruginosa (P. aeruginosa) (26.54%) was the predominant G- bacterium, and Staphylococcus (S.) aureus (24.78%) was the most common G+ bacterium. In 2014, P. aeruginosa (30.10%) and S. aureus (23.30%) remained prevalent. By 2020, P. aeruginosa (35.14%) increased further, while S. aureus (7.43%) decreased significantly (p < 0.001). Antibiotic sensitivity varied over the years, with older antibiotics showing decreased efficacy and newer classes demonstrating increased sensitivity. Conclusion. Throughout the study period, there was a notable shift toward G- bacterial dominance, particularly P. aeruginosa. Antibiotic resistance patterns also evolved. This study highlights the importance of local surveillance of bacterial flora of VLUs and antibiotic resistance profiles.

References

Stanek A, Mosti G, Nematillaevich TS, Valesky EM, Planinšek Ručigaj T, Boucelma M, et al. No More Venous Ulcers-What More Can We Do? J Clin Med 2023; 12(19): 6153.

Schneider C, Stratman S, Kirsner RS. Lower Extremity Ulcers. Med Clin North Am 2021; 105(4): 663–79.

O'Donnell TF Jr, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum. J Vasc Surg 2014; 60(2 Suppl): 3S–59S.

Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle) 2015; 4(9): 560–82.

Probst S, Saini C, Gschwind G, Stefanelli A, Bobbink P, Pugliese MT, et al. Prevalence and incidence of venous leg ulcers-A systematic review and meta-analysis. Int Wound J 2023; 20(9): 3906–21.

Coelho GA, Secretan PH, Tortolano L, Charvet L, Yagoubi N. Evolution of the Chronic Venous Leg Ulcer Microenviron-ment and Its Impact on Medical Devices and Wound Care Therapies. J Clin Med 2023; 12(17): 5605.

Pugliese DJ. Infection in Venous Leg Ulcers: Considerations for Optimal Management in the Elderly. Drugs Aging 2016; 33(2): 87–96.

Herman TF, Bordoni B. Wound Classification. [updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncb

i.nlm.nih.gov/books/NBK554456/

Howell-Jones RS, Wilson MJ, Hill KE, Howard AJ, Price PE, Thomas DW. A review of the microbiology, antibiotic usage and resistance in chronic skin wounds. J Antimicrob Chemother 2005; 55(2): 143–9.

Landis SJ. Chronic wound infection and antimicrobial use. Adv Skin Wound Care 2008; 21(11): 531–40; quiz 541–2.

Cwajda-Białasik J, Mościcka P, Jawień A, Szewczyk MT. Microbi-ological Status of Venous Leg Ulcers and Its Predictors: A Single-Center Cross-Sectional Study. Int J Environ Res Public Health 2021; 18(24): 12965.

Matei SC, Dumitru CS, Fakhry AM, Ilijevski N, Pešić S, Petrović J, et al. Bacterial Species Involved in Venous Leg Ulcer Infec-tions and Their Sensitivity to Antibiotherapy–An Alarm Signal Regarding the Seriousness of Chronic Venous Insufficiency C6 Stage and Its Need for Prompt Treatment. Microorganisms 2024; 12(3): 472.

Lim CS, Baruah M, Bahia SS. Diagnosis and management of venous leg ulcers. BMJ 2018; 362: k3115.

Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T 2015; 40(4): 277–83.

Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of Antibi-otics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals (Basel) 2023; 16(11): 1615.

Tuttle MS. Association Between Microbial Bioburden and Healing Outcomes in Venous Leg Ulcers: A Review of the Evidence. Adv Wound Care (New Rochelle) 2015; 4(1): 1–11.

O'Meara S, Al-Kurdi D, Ologun Y, Ovington LG, Martyn-St James M, Richardson R. Antibiotics and antiseptics for venous leg ul-cers. Cochrane Database Syst Rev 2014; 2014(1): CD003557.

Fonder MA, Lazarus GS, Cowan DA, Aronson-Cook B, Kohli AR, Mamelak AJ. Treating the chronic wound: A practical ap-proach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol 2008; 58(2): 185–206.

Valencia IC, Falabella A, Kirsner RS, Eaglstein WH. Chronic venous insufficiency and venous leg ulceration. J Am Acad Dermatol 2001; 44(3): 401–21; quiz 422–4.