Bacterial cultures, rapid strep test, and antibiotic treatment in infected hard-to-heal ulcers in primary care

Abstract

Objective. In-depth studies on antibiotic treatment for patients with hard-to-heal ulcers in primary care are lacking. The present study was undertaken to update the bacteriological spectrum for this patient group and to investigate antibiotic treatment. A further aim was to investigate the potential of a rapid strep test to find group A streptococci (GAS) causing ulcer infection. Design. A prospective study from August 2009 to August 2010. Setting. Blekinge Wound Healing Center. Subjects. Patients with clinical signs of infected hard-to-heal ulcers of any etiology. Main outcome measures. A bacterial culture and a rapid strep test were taken from every ulcer to capture the bacteriological spectrum. Antibiotic treatment before and during the study period was measured. Results. Forty-one patients with 49 infected ulcers were recruited. Staphylococcus aureus, found in 68.8% of all cultures, was the most observed species. Group G streptococci (GGS) were found in 12.5%. GAS was found in one case where the rapid strep test was positive. Staphylococcus aureus was found in three patients out of four with clinical signs of erysipelas. Some 59% of the patients were treated with antibiotics before the study period compared with 44% during the study period. Conclusion. Antibiotic treatment was largely reduced because of structured wound management. The current bacteriological spectrum showed high rates of GGS and erysipelas caused by Staphylococcus aureus. The rapid strep test was found useful in identifying GAS but we would not recommend its use in the clinical setting due to the low rate of GAS in this patient group.