Bacteriological Profiles and Antimicrobial Resistance in Chronic Leg Ulcers: A Culture-based Study

Introduction: Chronic leg ulcers (CLUs) are common in the elderly and cause significant morbidity and public health problems. Staphylococcus aureus was the most prevalent organism in CLU, and the majority of them were methicillin-resistant. Other Gram-negative organisms are also multidrug resistant, which are isolated from CLU. The study aims to determine the bacterial profile and antimicrobial susceptibility pattern of patients with CLU. Materials and Methods: An observational study was conducted on 143 patients with CLU for 2 years at a tertiary care hospital in western Maharashtra, India. A detailed history of the patients was recorded in a predetermined pro forma. Samples were collected aseptically and processed in the microbiology department as per standard protocol. Bacterial identification and antibiotic susceptibility were performed using conventional and/or automated methods. Various phenotypic drug-resistant enzyme detection methods for the isolated organisms. We assessed the patients’ details regarding risk factors associated with CLU. Post the dispatch of the antimicrobial susceptibility report, escalation or de escalation of antibiotic treatment was observed in CLU patients. Results: Among the CLU patients, 117 were males and 26 were females. One hundred and sixteen samples yielded bacterial growth. S. aureus was the most common organism (27%), followed by Pseudomonas aeruginosa (17%). Among S. aureus isolates, 53% were methicillin-resistant. Among the Gram-negative isolates, extended spectrum beta lactamase (36%) and metallo beta lactamase (46%) production was highest among Escherichia coli . A risk factors assessment found diabetes mellitus as the most common (87.41%) factor. The majority of the patients were diabetic, and good glycemic control was shown only in 32%, while 67% showed poor glycemic control. Out of 116 culture-positive patients, 84 (72%) had a change in empiric antibiotics. Conclusion: S. aureus is the predominant followed by P. aeruginosa in CLUs. Multidrug-resistant organisms have increased due to the inadvertent use of antibiotics. Empiric antimicrobial therapy should be tailored according to the institutional antibiogram and culture and sensitivity report.