Infection Management in Chronic Vascular Ulcers

Infection is one of the complications of chronic leg ulcers (CLU). It can also interrupt wound healing and affect the amputation rate. This prospective study was done from November 2005 until July 2007 in Vascular Surgery Department of Imam Reza Hospital, Mashhad University of Medical Sciences. Infection rate of 100 CLU on amputated limbs were evaluated. Underlying disease was arthrosclerosis in 12%, Buerger’s Disease in 20% and Diabetes in 68% of the patients. Ulcers with duration of more than 3 months were considered chronic. The patients with ulcer duration more than 1 month whose leg amputation was performed due to severe pain (Buerger’s Disease), gangrene or signs of severe infection were also included. Infection was suggested by tissue culturing from the base of the ulcer before amputation. 2-5cc sterile isotonic saline from the intact clean skin was injected to the base of the ulcer and aspirated for culturing to compare with the results of tissue culture. The sensitivity of needle-aspiration test for aerobic culture was 91%, the specifity 81%, positive predictive value 95% and negative predictive value 71%. For anaerobic needle-aspiration culture, sensitivity 90%, specifity of 87.5%, positive predictive value of 94% and negative predictive value of 80% were found. Since the signs of infection in ischemic ulcers can be furtive and due to presence of high antibiotic resistance of attained pathogens in this study and owing to the fact of resemblance between the results of tissue culture and aspiration culture, performing aspirated culture from every CLU and the antibiotic therapy based on the results of antibiogram may be suggested.