EUROPEAN  TISSUE  REPAIR  SOCIETY

It is necessary to appreciate that anaerobic bacteria are slow growing and take up to 72 hours to yield growth on laboratory diagnostic plates. Furthermore, since the most acute infections such as beta-haemolytic streptococci, especially those of Lancefield group A & B and Pseudomonas and Klebsiella yield detectable growth in 24 hours, the diagnostic laboratory is required, for clinical reasons, to send out reports the day after receiving the specimen. Consequently, the absence of anaerobic bacteria in these first reports are NOT diagnostic of their absence. Unless a report on prolonged culture for 72 hours or more is received, the absence of anaerobic bacteria cannot be assumed.

Anaerobic bacteria in particular Prevotella melanino-genicus, bacteroides fragilis and anaerobic streptococci, are the organisms responsible for the faecal smell of mal-odorous wounds. Therefore always treat malodorous wounds with metronizadole ointment, since drug resistance never occurs with this agent. Treatment should be at least daily and should continue for five days. This treatment is important not only because of the social implications of the malodour, but because anaerobic infections prevent phagocytosis by the polymorphs of other pathogenic bacteria present in the wound.

Usually antibacterial treatment is adequately performed with silver sulphonamide ointment or polymyxin ointments or spray with little risk if any, of the development of drug resistance. However, if the ulcer shows a spreading red edge (cellulitis) and a swab reveals the presence of any beta-haemolytic streptococci, systemic treatment with a betalactamase resistant penicillin, such oral Flucloxacillin, should be started immediately and continued for five days.