title: Phenotypic, molecular and antimicrobial susceptibility assessment in isolates from chronic ulcers of cured leprosy patients: a case study in Southern Brazil.
abstract: BACKGROUND
  One of the most stigmatizing physical sequelae of leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections.
  
  
  OBJECTIVE
  To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy.
  
  
  METHODS
  After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Samples were collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus (MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing.
  
  
  RESULTS
  Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureus and Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec).
  
  
  CONCLUSIONS
  In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV.
authors.affiliation: Faculdade Serra da Mesa, Uruaçu, GO, Brazil.
authors.forename: Luciane Cristina
authors.initials: LC
authors.lastname: Gelatti
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Renan Rangel
authors.initials: RR
authors.lastname: Bonamigo
authors.affiliation: Centro Universitário Franciscano, Santa Maria, RS, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Becker
authors.affiliation: Ambulatório de Dermatologia Sanitária, Secretaria Estadual de Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Letícia Maria
authors.initials: LM
authors.lastname: Eidt
authors.affiliation: Hospital Mãe de Deus, Porto Alegre, RS, Brazil.
authors.forename: Letícia
authors.initials: L
authors.lastname: Ganassini
authors.affiliation: Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Pedro Alves
authors.initials: PA
authors.lastname: d' Azevedo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification*; D015373:Bacterial Typing Techniques; D001938:Brazil; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000382:microbiology; D007918:Leprosy / Q000150:complications*; D035002:Lower Extremity / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D064307:Microbiota; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011550:Pseudomonas aeruginosa / Q000235:genetics / Q000302:isolation & purification; D012883:Skin Ulcer / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000382:microbiology*