Site-specific bacteriology of tropic ulcers and their antibiotic sensitivity: A cross-sectional study

Abstract

Introduction: The trophic ulcers are usually presented in the form of diabetic ulcer, leprotic ulcer, and pressure ulcer. The usual site for ulceration in trophic ulcer is the bony prominence on body part devoid of sensation. The chronic wounds management in health-care setting have significant impact on the patient's physical, mental, and financial health. In trophic ulcer management factors such as cause of ulcer, its location, size, and duration should be considered. Infection in such trophic ulcer leads to increase disease activity results delayed wound healing. Thus, a study was designed with aim to find relation between location of trophic ulcer and its infection status. Materials and Methods: This retrospective cross-sectional study includes 95 patients with infected trophic ulcers admitted between January 2015 and March 2020 from our tertiary care rehabilitation center. Cultured bacterial species were tested against following 23 drugs Amikacin, Gentamycin, Levofloxacin Ciprofloxacine, Piperacillin + Tazobactum, Ceftriaxone, Cefepime, Meropenem, Imipenem, Ampicillin, Ceftazidime, Amoxiclav, Cotrimoxazole, Cefotaxime, Erythromycin, Clindamycin, Tetracycline, Cefoxitin, Chloramphenicol, Colistin, Tobramycin, Vancomycin, and Aztreonam. Results: The common sites of trophic ulcer involvement were sacrum (32%), heel (29%), forefoot (17%), ischium (12%), knee (6%), and greater trochanter (4%). Eight different bacterial species were isolated, which were Staphylococcus aureus (26%), Enterococcus (9%) and six Gram-negative bacteria, which were Pseudomonas (24%), Proteus (17%), Klebsiella (11%), E. coli (7%), Enterobacter (3%), and Acinetobacter Baumani (3%). S. aureus was found most susceptible to Vancomycin (16%), followed by Amikacin (14%) and full resistant to ampicillin, tobramycin, and Aztreonam. Pseudomonas was found most susceptible to Meropenem (13%), followed by Amikacin (12%) and full resistant to Cotrimoxazole, Erythromycin, Clindamycin, Cefoxitin, Chloramphenicol, and Vancomycin. Overall, Amikacin followed by Meropenem was found susceptible against 56% and 52% of cases, respectively. Conclusion: The infected trophic ulcers which require either medical or surgical treatment, in both these situations antibiotics play vital role, thus, to avoid the development of antibiotics resistant, two drug regimens should be followed either by adding Amikacin or Meropenem to the primary single drug regime.