THE MICROBIAL-FLORA IN VENOUS LEG ULCERS WITHOUT CLINICAL SIGNS OF INFECTION - REPEATED CULTURE USING A VALIDATED STANDARDIZED MICROBIOLOGICAL TECHNIQUE

The change of ulcer size in relation to the presence of species and qu antities of microorganisms was analysed in 58 patients with venous leg ulcers, all without clinical signs of infection. Microbiological samp les were taken on the day of inclusion and then repeated 4 times at mo nthly intervals or until the ulcer had healed or was too small to be c ultured from. There was growth of microorganisms in all ulcers, and th e numbers were below 10(4) per mm(2) of ulcer surface in all cases. No correlation was found between ulcer size change and the species and a mounts of microorganisms. Sixty-nine species were isolated. Staphyloco ccus aureus was found in 88%, Enterococcus faecalis in 74%, Enterobact er cloacae and Peptococcus magnus in 29%, and fungi in 11% of the samp les. One or more obligate anaerobe species was found in 41% of the sam ples and in half of the ulcers and constituted 62% of all bacterial sp ecies. The colonising ulcer flora was markedly constant over time in t he individual ulcers regardless of change in size. Resident bacterial species were found in 57 of the 58 ulcers. If all samples mere conside red, the microorganisms were associated with not more than one fifth o f the variability in healing rate, as shown by linear multiple regress ion analysis. The same species of microorganisms were found in ulcers that decreased (or healed) and in those that increased in size. Althou gh an association between the microorganisms and ulcer healing could n ot be ruled out in this study, there seems to be no indication for rou tinely performed culture in the absence of clinical signs of infection in venous leg ulcers.