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