THE EFFECT OF SYSTEMIC ANTIBIOTICS ON THE BACTERIAL-FLORA OF CHRONIC WOUNDS

Experience in a comprehensive wound management program suggested that under carefully controlled circumstances systemic antibiotics play an important role in managing the chronic wound. Thirty-seven consecutive patients who were part of this program and whose wounds were not maki ng satisfactory progress toward healing were selected based on a quant itative tissue culture showing greater than 10(5) organisms per gram o f tissue. Six were excluded, leaving a study population of 31 patients . Organisms recovered included coagulase positive staphylococcus in 11 patients, methacillin resistant staphylococcus aureus in 10, pseudomo nas in eight, coagulase negative staphylococcus in eight, diphtheroids in six, klebsiella in three, enterococcus in three and Acinitobacter, candida, Seratia, and streptococci in a lesser number. Organisms reco vered in numbers less than 10(5) were not specifically treated. Multip le organisms were recovered in 18/31 patients. These patients were tre ated with systemic antibiotics based on sensitivities and recultured a t least 10 days to two weeks later. Antibiotics included vancomycin in 10 patients, cephlexin in nine, ciprofloxacin in five and imipenem, a moxicillin/clavulanate, chloromycetin, trimethoprim/sulfa, fluconazole , and others in smaller numbers of patients. Most patients were treate d as outpatients or in skilled nursing facilities. Antibiotics were ad ministered orally or parenterally by home care nurses. Wound managemen t remained the same before and during the study. Twenty-six patients ( 84 percent) developed negative cultures, three patients (10 percent) h ealed before follow-up culture was obtained and two patients (6 percen t) failed to clear their cultures during follow-up. The bacterial flor a of the wounds changed during antibiotic therapy in six patients. In five patients a change in antibiotic produced clearing of the culture. The sixth patient was noncompliant in his wound care. Of the two pati ents who did not respond one was noncompliant and the other was a diab etic whose methacillin resistant staphylococci continued in spite of w ound care and vancomycin therapy. Systemic antibiotics will decrease t he bacterial burden of a chronic wound when used in conjunction with a comprehensive wound management program.