Microbiology of chronic leg and pressure ulcers: clinical significance and implications for treatment.

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.