title: Cryptic Bacteria of Lower Limb Deep Tissues as a Possible Cause of Inflammatory and Necrotic Changes in Ischemia, Venous Stasis and Varices, and Lymphedema.
abstract: BACKGROUND
  Infections and inflammation of the lower limb skin, soft tissues, and vessels are more common than in other body regions. The aim was to determine whether cryptic bacteria dwelling in deep tissues are the cause.
  
  
  METHODS
  We performed bacteriologic studies of specimens harvested from arteries of amputated ischemic legs, leg varices, and tissue fluid/lymph and lymphatics in lymphedema.
  
  
  RESULTS
  Calf arteries contained isolates in 61% and femoral arteries in 36%, whereas normal cadaveric organ donors' arteries in 11%. Bacterial deoxyribonucleic acid (DNA) was detected in 70%. The majority of isolates belonged to the coagulase-negative staphylococci and Staphylococcus aureus; however, highly pathogenic bacteria were also detected. All were sensitive to all antibiotics except penicillin. Saphenous vein varices contained bacterial cells in 40% and controls 4%; bacterial DNA was found in 69%. The majority of bacteria were S. epidermidis and S. aureus susceptible to all antibiotics except penicillin, Lymph and epifascial lymphatics limb contained bacteria in 60% and 33% samples, respectively and controls in 7%. Most were S. epidermidis susceptible to all antibiotics except penicillin.
  
  
  CONCLUSIONS
  Cryptic bacteria are present in lower limb tissues and may play a pathologic role in surgical site infections. Proper antibacterial prophylaxis should be considered when planning surgical interventions.
authors.affiliation: 1Department of Surgical Research Transplantation and Human Epigenetics, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.|2Department of Transplantation Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland.
authors.forename: Waldemar L
authors.initials: WL
authors.lastname: Olszewski
authors.affiliation: 1Department of Surgical Research Transplantation and Human Epigenetics, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
authors.forename: Marzanna
authors.initials: M
authors.lastname: Zaleska
authors.affiliation: 1Department of Surgical Research Transplantation and Human Epigenetics, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Stelmach
authors.affiliation: 3Department of Microbiology, Medical University, Warsaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Swoboda-Kopec
authors.affiliation: 4Institute of Medical Sciences, Benaras Hindu University, Varanasi, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Jain
authors.affiliation: 5Department of Burns, Plastic and Maxillofacial Surgery, Safdarjang Hospital and VM Medical College, New Delhi, India.
authors.forename: Karoon
authors.initials: K
authors.lastname: Agrawal
authors.affiliation: 6Amla Mediquip/Sanwari Bai Surgical Centre, New Delhi, India.
authors.forename: Sashi
authors.initials: S
authors.lastname: Gogia
authors.affiliation: 6Amla Mediquip/Sanwari Bai Surgical Centre, New Delhi, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Gogia
authors.affiliation: 2Department of Transplantation Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Andziak
authors.affiliation: 2Department of Transplantation Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland.|7Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Durlik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000382:microbiology; D035002:Lower Extremity / Q000382:microbiology* / Q000473:pathology*; D008209:Lymphedema / Q000209:etiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D018461:Soft Tissue Infections / Q000209:etiology* / Q000382:microbiology; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology; D014648:Varicose Veins / Q000209:etiology* / Q000382:microbiology