A prospective observational study was carried out in a tertiary care institute to evaluate the demographic, clinical and microbiological profile of patients who presented to the Department of Burns and Plastic Surgery with chronic wounds that were present for ≥3weeks duration.  These wounds had variable etiologies. The study duration was one year from October 2018 to September 2019 and included 103 patients. Most (78.64%, n=81) of the chronic wounds were found to be located in the lower extremities. 

The wounds were examined and photograph followed by wound swabs for culture and sensitivity. Empiric treatment was initiated depending on the clinical presentation and modified, if required, based on culture and sensitivity report. Patients were followed-up for six months after the wound healed.

Ninety-nine pathogenic organisms belonging to 17 different species were isolated; gram-negative organisms were more common than gram-positive organisms; 62 vs 37 isolates, respectively. The most common bacterial species detected was Staphylococcus aureus (30/99) followed by Pseudomonas aeruginosa (20/99). A high prevalence of infections caused by gram-negative bacteria (Klebsiella pneumoniae, Escherichia coli and Proteus mirabilis) was also observed. Although chronic wounds are generally polymicrobial, in this study a single organism was isolated from most wounds (72%); there were 10.67% wounds with 2 species isolated and 7.76% wounds with ≥ 3 species isolated. According to the study authors, these findings should be taken into consideration when deciding on empirical antibiotic in patients with wound infection. 

Seventy-four (71.84%) patients required a surgical intervention for wound closure. The most commonly used surgical intervention was split-thickness skin grafting, which was done in 45 (43.68%) patients. The other surgical interventions used were local and distant flaps. Twenty-nine (28.15%) patients were managed conservatively with debridement and dressings. Significant differences in the patterns of antimicrobial resistance were also observed. All patients, except four, achieved wound closure.

In chronic wounds that do not respond to standard treatment, culture of the causative pathogen followed by specific anti-microbial therapy is important to avoid indiscriminate use of antibiotics. Around 63% patients required wound cover with a surgical flap. Early referral to reconstructive services therefore may shorten wound healing and improve clinical outcomes.

Khan MM, et al. Chronic wound care Manag Res. 2020;7:43-51.