Are there clinical signs and symptoms of infection to indicate the presence of multidrug-resistant bacteria in venous ulcers?

• Published in: Journal of vascular nursing Vol. 35; no. 4; pp. 178 - 186
• Main Authors: dos Santos, Silvana de Lima Vieira, Martins, Marlene Andrade, do Prado, Marinésia Aparecida, Soriano, José Verdú, Bachion, Maria Márcia
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Cross Infection - prevention & control; Cross-Sectional Studies; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Nursing; Occlusive Dressings; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Varicose Ulcer - drug therapy; Varicose Ulcer - microbiology; Wound Healing
• ISSN: 1062-0303; 1532-6578
• DOI: 10.1016/j.jvn.2017.08.001

The selection of topical and systemic therapies for the treatment of venous ulcers with signs of infection is challenging and should be accompanied by specific precautionary measures to protect against cross-contamination in the presence of multidrug-resistant microorganisms. However, there are still no clinical indicators for this situation, and confirmation of resistant strains occurs through culture and sensitivity, which can take up to 14 days. During this period, protective measures may no longer be taken, contributing to the spread of these pathogens. This study aimed to analyze the relationship between clinical signs and symptoms of infection in venous ulcers and the presence of antimicrobial-resistant Staphylococcus aureus and/or Pseudomonas spp. A cross-sectional study was developed including 69 patients with 98 venous ulcers. Clinical observation protocol was applied to detect infection indicators established by the European Wound Management Association and microbiological analysis of samples of the lesions. Fisher's exact test and χ2 were used for analyses (P < 0.05). Two indicators of infection predominated (f >70%): discoloration of the opaque type and/or dark brick red and increased exudate volume; 31 (31.6%) ulcer samples showed positive culture for the bacteria studied. There was no relationship between signs and symptoms of infection and the presence of multidrug-resistant microorganisms. Taking into account the percentage of lesions with resistant strains, for safe care, contact precautionary measures should be implemented in the treatment rooms, in addition to standard precautions.