Patterns of wound colonisation in patients with peripheral vascular disease

The bacterial colonisation of ulcers related to vascular disease, amputation sites and sites of surgical vascular repair was studied in 122 patients with vascular disorders. Wounds were graded clinically on the basis of inflammation, oedema and exudate. They were sampled at weekly intervals in order to determine the duration of colonisation. The significance of potential pathogens was assessed. Vascular ulcers were of low mean wound grade (1.87), short duration (1.58 weeks) and potential pathogens were isolated from 82% of 38 wounds. Amputation sites were of a higher mean wound grade (2.48) and longer duration (2.52 weeks) when compared to vascular ulcers. Potential pathogens were isolated from 69% of 42 amputation sites. Sites of surgical vascular repair were similar to amputation sites with respect to mean wound grade (2.33) but of a mean duration (1.69 weeks) similar to that of vascular ulcers. Potential pathogens were isolated from 50% of 42 surgical vascular repair sites but they were not evenly distributed among limb (33%), groin (55%) and abdominal wounds (71%). Coliforms were isolated from similar numbers of all wounds. Pseudomonas spp., Staphylococcus aureus and Streptococcus faecalis were evenly distributed with respect to the site of isolation. Pseudomonas spp. and S. aureus were associated more commonly with vascular ulcers and S. faecalis with sites of surgical vascular repair. The use of topical antiseptics and/or systemic antimicrobial agents had a minimal effect in reducing colonisation/infection in the wounds studied.