tetracycline and Varicose-Ulcer

In this retrospective investigation, we documented the bacterial colonization of 79 patients with chronic wounds, who had been treated between January 2002 and May 2003 in an outpatient wound healing clinic of a university dermatology program. We isolated 106 facultative pathogenic bacterial strains of which 56 were Staphylococcus aureus, 19 Pseudomonas aeruginosa, 11 Escherichia coli, 4 Proteus mirabilis, 4 Enterobacter cloacae, 2 Serratia marcescens, 2 Streptococcus group G und 8 further species. 68 of these bacterial strains were gram-positive and 46 gram-negative. Moreover we identified one patient with Candida parapsilosis. Therefore, 70.8% of all patients showed Staphylococcus aureus in their chronic wounds. Determination of the specific resistances showed 17 patients to be colonized with oxacillin- resistant Staphylococcus aureus (ORSA) strain; this corresponds to 21.5% of all patients. Consequently, 30.4% of all Staphylococcus aureus isolates were ORSA strains. All of the ORSA isolates were sensitive to vancomycin. Sensitivity to tetracycline was documented in 15, to amikacin in 13, to clindamycin in 7, to gentamicin and erythromycin in 6 of the ORSA-positive patients. In the case of trimethoprim/sulfamethoxazole, 10 were sensitive and 3 were intermediate in sensitivity. Beside the obligate resistance to oxacillin, penicillin G, ampicillin, cefuroxime and imipenem, none of the ORSA was sensitive to ofloxacin. The results of our investigations demonstrate the actual spectrum of bacterial colonization in chronic wounds of patients in an university dermatologic wound clinic and underline the growing problem of ORSA.

Topics: Aged; Aged, 80 and over; Bacteriological Techniques; Chronic Disease; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Foot Ulcer; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Oxacillin; Penicillin Resistance; Pressure Ulcer; Radiodermatitis; Skin Diseases, Bacterial; Skin Ulcer; Staphylococcal Skin Infections; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Vancomycin Resistance; Varicose Ulcer; Wound Infection

A strain of Staphylococcus aureus isolated from the skin of a subject with eczema showed a loss in resistance to neomycin and tetracycline after treatment with neomycin was stopped. Seven out of 22 strains of neomycin-resistant Staph. aureus showed a loss in resistance to neomycin and streptomycin after storage in nutrient broth for 14 days at room temperature, and it seems probable that resistance in these unstable strains was controlled by extrachromosomal elements or plasmids. Strains of phage types 84/85 and 29/77 and related types were frequently isolated in general hospital wards and showed no loss in resistance on similar storage in nutrient broth. Five of the neomycin-unstable strains were isolated from patients with eczematous lesions. Multiple-resistant and antibiotic-sensitive strains of Staph. aureus of similar phage type were isolated from patients in a ward for patients with skin disease, and the possibility of transfer of resistance in vivo is discussed.

Topics: Drug Resistance, Microbial; Eczema; Extrachromosomal Inheritance; Genetics, Microbial; Humans; Neomycin; Preservation, Biological; Staphylococcus; Streptomycin; Tetracycline; Varicose Ulcer

Topics: Adult; Aged; Arthritis; Bacteria; Child; Drug Synergism; Drug Tolerance; Female; Humans; Male; Middle Aged; Osteomyelitis; Penicillin V; Phlebitis; Respiratory Tract Infections; Staphylococcus; Tetracycline; Varicose Ulcer