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Table 3 Microbiology Information collected from the patients with RA, had foot ulcers present in the study period and had swabs taken [swab group]

From: Prevalence and microbiological characteristics of clinically infected foot-ulcers in patients with rheumatoid arthritis: a retrospective exploratory study

Study No. Location of Ulcer Clinical Picture Microscopy Culture result Sensitivity detected Treatments/antibiotics used
1 Right 2nd toe Thick yellow pus type exudate coming from original ulcer and on exit wound of lateral border of apex. Same toe. Unable to probe as very painful. Skin flora ++ Non specified Co-Amoxiclav.
  10 weeks prescribed but only completed 3 weeks due to side effects.
Swabs from before the index swab:
41 days before: scanty skin flora
39 days before: skin flora +
X-ray 3 months before index swab showed osteomyelitis.
Antibiotics before index swab:
Bone removed 7 days after index swab for culture.  
39 days before: Flucloxacillin
41 days before: nil antibiotics
2 Left medial malleolus. Granular spreading infection – lot of exudate and spreading to deep tissue – probing more than 10 mm. X-ray taken. Swab rejected from microbiology as no location/no Consultant specified. N/A Flucloxacillin
15 days before index swab: wound clean, a granular base with no evidence of infection. 4 mm x 4 mm.
3 Plantar aspect of right 1st toe, IP joint. Index swab taken at start of ulcer. Mixed skin and enteric flora +++ Non specified Clarithromycin
Ulcer dressed by district nurse before referral to podiatry 107 days later.
4 Right 3rd plantar, MTP joint. Foot ulcer swab. Skin flora ++ with anaerobe ++ Non specified Flucloxacillin
5 Left 4th IP joint. Probe depth to bone. No clinical signs of infection. Skin flora + with anaerobe + Metronidazole None listed.
6 Left 2nd and 3rd toes. Ulcer x2 middle toes left foot. Staphylococcus aureus +++. Flucloxacillin sensitive Flucloxacillin
Documented as: May represent colonisation only. Suggest treat only if current clinical evidence of infection. Penicillin Resistant
Clarith/Eryth Sensitive.
7 Plantar lesion right hallux. 1st MTP joint. Deep ulcer under right hallux. Probing to bone. Aspirated bursa fluid sent to microbiology. Gram stain: no organisms seen Non specified None
Gram WBC: none seen
These samples are not routinely examined for crystals.
Culture: no growth
8 Left big toe. Infected rheumatoid nodule. Skin flora ++ with anaerobe ++ Non specified None stated
  May represent colonisation only.   
Skin flora + with Anaerobe ++
14 days after index swab: RA infected Left big toe Sensitive to Metronidazole Flucloxacillin
  1. The patient study numbers correlate with those in Table 1
  2. MTP metatarsophalangeal, IP interphalangeal, N/A not applicable