Microbiology of chronic leg and pressure ulcers: clinical significance and implications for treatment
Abstract
Chronic pressure ulcers and leg ulcers are common, especially in the elderly, and are a source of much distress and disability. Health care providers must distinguish between clinically unimportant but predictable colonization of these wounds and clinically relevant infection.Infection may present as increased local pain, cellulitis, local abscess,necrotizing fasciitis, osteomyelitis, bacteremia, or sepsis. For most of these conditions, systemic antibiotics are necessary. The use of topical antimicrobial agents as a means of promoting healing in clinically uninfected wounds is a subject of active investigation at this time. Currently, evidence is insufficient to support routine use of anti-microbial agents for this purpose. A quantitative tissue culture taken from the ulcer bed, revealing greater than 10(5) organisms/g of tissue appears to increase the risk of failure of ulcer wound closure by graft or flap. A short course of topical or systemic antibiotics before surgery in these instances is advisable.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
This polymicrobial bioburden in wounds exists predominantly in the form of a biofilm resistant to antimicrobial treatments.
“This polymicrobial bioburden in wounds exists predominantly in the form of a biofilm resistant to antimicrobial treatments [15], [16], [17], [18], [19].”
From Interactions of Methicillin Resistant Staphylococcus aureus USA300 and Pseudomonas aeruginosa in Polymicrobial Wound Infection (2013) · cites this paper as [16]
Cites
Martin, R. (1986) · Medical Entomology and Zoology · Cited by 8,743 · see citing works
KASS, E. H. (1957) · A.M.A. Archives of Internal Medicine · doi:10.1001/archinte.1957.00260110025004 · Cited by 678 · see citing works
Robson, M. C. (1997) · Surgical Clinics of North America · doi:10.1016/s0039-6109(05)70572-7 · Cited by 643 · see citing works
Pressure Ulcer Prevention and Management
Lyder, C. H. (2003) · JAMA · doi:10.1001/jama.289.2.223 · Cited by 443 · see citing works
Mitogenic activity and cytokine levels in non-healing and healing chronic leg ulcers
Trengove, N. J., Bielefeldt‐Ohmann, H., & Stacey, M. C. (2000) · Wound Repair and Regeneration · doi:10.1046/j.1524-475x.2000.00013.x · Cited by 432 · see citing works
Burnand, K. G., Whimster, I. W., Naidoo, A., & BROWSE, N. L. (1982) · BMJ · doi:10.1136/bmj.285.6348.1071 · Cited by 350 · see citing works
Criteria for identifying wound infection
CUTTING, K. F., & Harding, K. G. (1994) · Journal of Wound Care · doi:10.12968/jowc.1994.3.4.198 · Cited by 310 · see citing works
EXPERIMENTAL STAPHYLOCOCCAL INFECTIONS IN THE SKIN OF MAN
Elek, S. D. (1956) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1956.tb36626.x · Cited by 272 · see citing works
O’Meara, S., Cullum, N. A., Majid, M., et al. (2001) · Health Technology Assessment · doi:10.3310/hta4210 · Cited by 264 · see citing works
Systematic review of antimicrobial agents used for chronic wounds
O’Meara, S., Cullum, N. A., Majid, M., et al. (2001) · British journal of surgery · doi:10.1046/j.1365-2168.2001.01631.x · Cited by 235 · see citing works
The microbiology of infected and noninfected leg ulcers
Bowler, P. G., & Davies, B. J. (1999) · International Journal of Dermatology · doi:10.1046/j.1365-4362.1999.00738.x · Cited by 233 · see citing works
Hansson, C., Hoborn, J., Möller, A., & Swanbeck, G. (1995) · Acta Dermato Venereologica · doi:10.2340/00015555752430 · Cited by 197 · see citing works
Bacteremia in a Long-Term-Care Facility: A Five-Year Prospective Study of 163 Consecutive Episodes
Muder, R. R., Brennen, C., Wagener, M. M., & Goetz, A. M. (1992) · Clinical Infectious Diseases · doi:10.1093/clinids/14.3.647 · Cited by 196 · see citing works
Qualitative bacteriology and leg ulcer healing
Trengove, N. J., Stacey, M. C., McGechie, D., Stingemore, N., & Mata, S. (1996) · Journal of Wound Care · doi:10.12968/jowc.1996.5.6.277 · Cited by 195 · see citing works
Sepsis associated with decubitus ulcers
Galpin, J. E., CHOW, A. W. C., Bayer, A. S., et al. (1976) · The American Journal of Medicine · doi:10.1016/0002-9343(76)90371-5 · Cited by 193 · see citing works
Infected Pressure Ulcers in Elderly Individuals
Livesley, N., & CHOW, A. W. C. (2002) · Clinical Infectious Diseases · doi:10.1086/344059 · Cited by 173 · see citing works
THE SUCCESSFUL CONTROL OF BURN WOUND SEPSIS
Moncrief, J. A., SWITZER, W. E., Order, S. E., et al. (1965) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/00005373-196509000-00004 · Cited by 170 · see citing works
Pseudomonas burn wound sepsis. I
Teplitz, C., Davis, D., Mason, A. D., et al. (1964) · Journal of Surgical Research · doi:10.1016/s0022-4804(64)80026-3 · Cited by 157 · see citing works
Rh, B., NUCCIO, P. A., Wolfe, E. T., COLLINS, B., Tamburro, C., Glass, W., & Cm, M. (1964) · PubMed · Cited by 147 · see citing works
Schmidtchen, A., Holst, E., Tapper, H., & Björck, L. (2003) · Microbial Pathogenesis · doi:10.1016/s0882-4010(02)00197-3 · Cited by 137 · see citing works
Bacteremia Associated With Decubitus Ulcers
Bryan, C. S. (1983) · Archives of Internal Medicine · doi:10.1001/archinte.1983.00350110079019 · Cited by 136 · see citing works
THE EFFECT OF BACTERIAL COLONIZATION ON VENOUS ULCER HEALING
Halbert, A., Stacey, M. C., Rohr, J. B., & Jopp‐McKay, A. G. (1992) · Australasian Journal of Dermatology · doi:10.1111/j.1440-0960.1992.tb00083.x · Cited by 131 · see citing works
Infections in Patients with Spinal Cord Injuries
Montgomerie, J. Z. (1997) · Clinical Infectious Diseases · doi:10.1086/516144 · Cited by 127 · see citing works
Quantitative microbiology of pressure sores in different stages of healing
Sapico, F. L., Ginunas, V. J., Thornhill-Joynes, M., Canawati, H. N., Capen, D. A., Klein, N. E., Khawam, S., & Montgomerie, J. Z. (1986) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/0732-8893(86)90089-1 · Cited by 120 · see citing works
Use of molecular techniques to study microbial diversity in the skin: Chronic wounds reevaluated
Davies, C. E., Wilson, M. J., Hill, K. E., Stephens, P., Hill, C., Harding, K. G., & Thomas, D. W. (2001) · Wound Repair and Regeneration · doi:10.1046/j.1524-475x.2001.00332.x · Cited by 117 · see citing works
Osteomyelitis Beneath Pressure Sores
Sugarman, B. (1983) · Archives of Internal Medicine · doi:10.1001/archinte.1983.00350040073010 · Cited by 111 · see citing works
Osteomyelitis Associated With Pressure Sores
Darouiche, R. O. (1994) · Archives of Internal Medicine · doi:10.1001/archinte.1994.00420070067008 · Cited by 107 · see citing works
Issues and Dilemmas in the Prevention and Treatment of Pressure Ulcers: A Review
Thomas, D. R. (2001) · The Journals of Gerontology Series A · doi:10.1093/gerona/56.6.m328 · Cited by 107 · see citing works
Stephens, P., Wall, I. B., Wilson, M. J., Hill, K. E., Davies, C. E., Hill, C., Harding, K. G., & Thomas, D. W. (2003) · British Journal of Dermatology · doi:10.1046/j.1365-2133.2003.05232.x · Cited by 106 · see citing works
Oxygen tension on the skin of the gaiter area of limbs with venous disease
Clyne, C. A. C., Ramsden, W. H., Chant, A. D. B., et al. (1985) · British journal of surgery · doi:10.1002/bjs.1800720820 · Cited by 90 · see citing works
Analysis of Antibiotic Susceptibilities of Skin Wound Flora in Hospitalized Dermatology Patients
Colsky, A. S., Kirsner, R. S., & Kerdel, F. A. (1998) · Archives of Dermatology · doi:10.1001/archderm.134.8.1006 · Cited by 89 · see citing works
Aerobic and anaerobic microbiology of chronic venous ulcers
Brook, I., & Frazier, E. H. (1998) · International Journal of Dermatology · doi:10.1046/j.1365-4362.1998.00445.x · Cited by 87 · see citing works
Quality Indicators for Prevention and Management of Pressure Ulcers in Vulnerable Elders
Bates‐Jensen, B. M. (2001) · Annals of Internal Medicine · doi:10.7326/0003-4819-135-8_part_2-200110161-00014 · Cited by 77 · see citing works
Molecular analysis of the microflora in chronic venous leg ulceration
Hill, K. E., Davies, C. E., Wilson, M. J., Stephens, P., Harding, K. G., & Thomas, D. W. (2003) · Journal of Medical Microbiology · doi:10.1099/jmm.0.05030-0 · Cited by 70 · see citing works
Meakins, J. (1996) · Archives of Surgery · doi:10.1001/archsurg.1996.01430240043005 · Cited by 62 · see citing works
Murdoch, D. A., Mitchelmore, I. J., & Tabaqchali, S. (1994) · Journal of Medical Microbiology · doi:10.1099/00222615-41-1-36 · Cited by 61 · see citing works
A Failure of Wound Healing Caused by an Imbalance of Bacteria
Robson, M. C. (1997) · Cited by 56 · see citing works
Pressure sores and underlying bone infection.
Sugarman, B. (1987) · PubMed · Cited by 52 · see citing works
Differential Proteinase Expression by Pseudomonas aeruginosa Derived from Chronic Leg Ulcers
Schmidtchen, H. W. A. (2001) · Acta Dermato Venereologica · doi:10.1080/000155501317208336 · Cited by 51 · see citing works
Pressure Sores and Underlying Bone Infection
Sugarman, B. (1987) · Archives of Internal Medicine · doi:10.1001/archinte.1987.00370030157030 · Cited by 47 · see citing works
Robson, M. C., & Heggers, J. P. (1969) · Journal of Surgical Research · doi:10.1016/0022-4804(69)90068-7 · Cited by 41 · see citing works
Assessing and controlling wound infection
Heggers, J. P. (2003) · Clinics in Plastic Surgery · doi:10.1016/s0094-1298(02)00072-x · Cited by 41 · see citing works
Effect of bacteriological status on pressure ulcer healing in patients with advanced cancer
Sopata, M., Łuczak, J., & Ciupińska, M. (2002) · Journal of Wound Care · doi:10.12968/jowc.2002.11.3.26678 · Cited by 39 · see citing works
Determination of bacterial burden in wounds.
Stotts, N. A. (1995) · PubMed · Cited by 34 · see citing works
Leg ulcer epidemiology in Gothenburg.
Hansson, C., Andersson, E., & Swanbeck, G. (1988) · PubMed · Cited by 31 · see citing works
Clindamycin for Treatment of Sepsis Caused by Decubitus Ulcers
CHOW, A. W. C., Galpin, J. E., & GUZE, L. B. (1977) · The Journal of Infectious Diseases · doi:10.1093/infdis/135.supplement.s65 · Cited by 29 · see citing works
Postoperative wound infections following myocutaneous flap surgery in spinal injury patients
Garg, M., Rubayi, S., & Montgomerie, J. Z. (1992) · Spinal Cord · doi:10.1038/sc.1992.141 · Cited by 23 · see citing works
Gas Gangrene Following Sacral Pressure Sores
Shibuya, H., Terashi, H., Kurata, S., et al. (1994) · The Journal of Dermatology · doi:10.1111/j.1346-8138.1994.tb01786.x · Cited by 21 · see citing works
Assessment of venous leg ulcers: an in-depth discussion of a literature-guided approach.
Kunimoto, B. (2001) · PubMed · Cited by 19 · see citing works
Pressure ulcers and infection--understanding clinical features.
Lindholm, C. (2003) · PubMed · Cited by 12 · see citing works
Necrotizing fasciitis: an uncommon consequence of pressure ulceration.
Kaplan, L. J., Pameijer, C. R., Blank-Reid, C. A., et al. (1999) · PubMed · Cited by 9 · see citing works
Walker, P. (2004) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/61.18.1906 · Cited by 5 · see citing works
Johnson, P. J., & Hollins, R. R. (2001) · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Pastar, I., Nusbaum, A. G., Gil, J., Patel, S. B., Chen, J., Valdes, J., Stojadinovic, O., Plano, L. R., Tomic-Canic, M., & Davis, S. C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0056846 · Cited by 391 · see citing works
- Authors
- Ebright, J. R.
- Affiliations
- Wayne State University (US)
- Corresponding author
- Ebright, John R.
- Venue
- Nursing Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2005-06
- Volume
- 40
- Issue
- 2
- Pages
- 207-216
- ISSN
- 0029-6465 (ISSN-L)
- OpenAlex
- W2084433793
- Cited by
- 31
- References
- 53
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 1 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 4 · 2012: 2
- FWCI
- 0.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nursing Clinics of North America (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Health Professions › Occupational Therapy › Pressure Ulcer Prevention and Management
- Keywords
- chronic pressure ulcers, leg ulcers, wound infection, wound colonization, necrotizing fasciitis, osteomyelitis, sepsis, topical antimicrobial agents, wound healing, surgical wound closure, elderly patients
- MeSH terms
- Chronic Disease, Pressure Ulcer, Humans, Leg Ulcer, Wound Healing, Wound Infection
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review