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

Fitzgerald P, Siddle HJ, Backhouse MR, Nelson EA - J Foot Ankle Res (2015)

Bottom Line: There was insufficient data to relate risk of clinical infection with risk factors.Further research is required to identify the most appropriate techniques for infection diagnosis, wound sampling and processing.Ethical approval was obtained from University of Leeds, Faculty of Medicine and Health (Reference number: SHREC/RP/349).

View Article: PubMed Central - PubMed

Affiliation: Harrogate Hospital, Lancaster Park Road, Horrogate, HG2 7SX UK.

ABSTRACT

Background: The prevalence of foot ulcers in patients with rheumatoid arthritis (RA) has been reported at almost 10 %. These foot ulcers often occur at multiple sites and are reoccurring, with the potential risk of infection increased due to RA diagnosis and disease modifying medications. The objective of this study was to estimate the prevalence of clinical infection in foot-ulcers of patients with RA; describe the microbiological characteristics and investigate risk factors.

Methods: Retrospective clinical data was collected for all patients attending a rheumatology foot ulcer clinic between 1st May 2012 and 1st May 2013: wound swab data was collected from those with clinical infection.

Results: Twenty-eight patients with RA and foot-ulcers were identified; eight of these patients had clinical infection and wound swabs taken (29 %). Of these eight patients there were equal men and women, with median age 74 years, and average disease duration 22 years. Cardiovascular disease/peripheral-vascular disease (CVD/PVD) were reported in six patients, diabetes in two patients. Six patients were treated with disease-modifying anti-rheumatic drugs (DMARDs); three were on biologic medications and two on steroids. Five wound swabs cultured skin flora, one staphylococcus aureus, one had no growth after culture; and one was rejected due to labelling error.

Conclusion: Almost a third of people with RA and foot ulcers attending clinic over one year had clinical infection, however microbiological analysis failed to isolate pathogens in six of seven wound swabs. This may be due to inaccurate diagnosis of ulcer infection or to issues with sampling, collection, transport, analysis or reporting. There was insufficient data to relate risk of clinical infection with risk factors. Further research is required to identify the most appropriate techniques for infection diagnosis, wound sampling and processing.

Trial registration: Ethical approval was obtained from University of Leeds, Faculty of Medicine and Health (Reference number: SHREC/RP/349).

No MeSH data available.


Related in: MedlinePlus

Flow Chart. Flow Chart to identify the eight patients with RA included in the analysis
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Fig1: Flow Chart. Flow Chart to identify the eight patients with RA included in the analysis

Mentions: Retrospective data was obtained from clinic notes and electronic records of all patients attending the weekly rheumatology foot-ulcer clinic in a large NHS teaching hospital Trust between 1st May 2012 and 1st May 2013; this determined the population size [Fig. 1].Fig. 1


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

Fitzgerald P, Siddle HJ, Backhouse MR, Nelson EA - J Foot Ankle Res (2015)

Flow Chart. Flow Chart to identify the eight patients with RA included in the analysis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4537588&req=5

Fig1: Flow Chart. Flow Chart to identify the eight patients with RA included in the analysis
Mentions: Retrospective data was obtained from clinic notes and electronic records of all patients attending the weekly rheumatology foot-ulcer clinic in a large NHS teaching hospital Trust between 1st May 2012 and 1st May 2013; this determined the population size [Fig. 1].Fig. 1

Bottom Line: There was insufficient data to relate risk of clinical infection with risk factors.Further research is required to identify the most appropriate techniques for infection diagnosis, wound sampling and processing.Ethical approval was obtained from University of Leeds, Faculty of Medicine and Health (Reference number: SHREC/RP/349).

View Article: PubMed Central - PubMed

Affiliation: Harrogate Hospital, Lancaster Park Road, Horrogate, HG2 7SX UK.

ABSTRACT

Background: The prevalence of foot ulcers in patients with rheumatoid arthritis (RA) has been reported at almost 10 %. These foot ulcers often occur at multiple sites and are reoccurring, with the potential risk of infection increased due to RA diagnosis and disease modifying medications. The objective of this study was to estimate the prevalence of clinical infection in foot-ulcers of patients with RA; describe the microbiological characteristics and investigate risk factors.

Methods: Retrospective clinical data was collected for all patients attending a rheumatology foot ulcer clinic between 1st May 2012 and 1st May 2013: wound swab data was collected from those with clinical infection.

Results: Twenty-eight patients with RA and foot-ulcers were identified; eight of these patients had clinical infection and wound swabs taken (29 %). Of these eight patients there were equal men and women, with median age 74 years, and average disease duration 22 years. Cardiovascular disease/peripheral-vascular disease (CVD/PVD) were reported in six patients, diabetes in two patients. Six patients were treated with disease-modifying anti-rheumatic drugs (DMARDs); three were on biologic medications and two on steroids. Five wound swabs cultured skin flora, one staphylococcus aureus, one had no growth after culture; and one was rejected due to labelling error.

Conclusion: Almost a third of people with RA and foot ulcers attending clinic over one year had clinical infection, however microbiological analysis failed to isolate pathogens in six of seven wound swabs. This may be due to inaccurate diagnosis of ulcer infection or to issues with sampling, collection, transport, analysis or reporting. There was insufficient data to relate risk of clinical infection with risk factors. Further research is required to identify the most appropriate techniques for infection diagnosis, wound sampling and processing.

Trial registration: Ethical approval was obtained from University of Leeds, Faculty of Medicine and Health (Reference number: SHREC/RP/349).

No MeSH data available.


Related in: MedlinePlus