[Chronic wounds and bacteria. Clinical relevance, detection and therapy]

The importance of bacteria in the treatment of patients with chronic wounds has been a focus of attention in recent years. A bacteriological swab taken from the wound in a Essen rotary technique is usually adequate for the diagnosis. The current detection rate of bacteria in patients with chronic leg ulcers in Germany is about 50 % for Staphylococcus aureus, 30 % for Pseudomonas aeruginosa and Enterobacteriaceae and approximately 10 % for MRSA. Most of these patients have a clinically unimportant bacterial colonization, so that systemic administration of antibiotics usually is not required. For wound cleansing only sterile solutions such as Ringer's or physiological saline solution should be used. If tap water is used, then the use of sterile filters is strongly recommended. In patients with increased risk of infection, a critical colonization or local signs of infection, modern wound antiseptics using polyhexanide or octenidine are available. The use of systemic antibiotics should be strictly limited to patients with systemic signs of infections.