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Venous Leg Ulcer — SCE Dermatology MCQ

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ModerateWound HealingVenous Leg UlcerSCE Dermatology

A 72-year-old man with multiple comorbidities develops a large chronic leg ulcer on his lower limb. Ankle brachial pressure index (ABPI) is 0.9. Swab grows Pseudomonas aeruginosa but there are no clinical signs of infection (no cellulitis, fever, or increasing pain). What is the most appropriate management of the Pseudomonas?

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Correct answer: B — No antibiotic treatment — treat the wound, not the colonisation

Chronic wounds are frequently colonised by bacteria including Pseudomonas without clinical infection. The principle of wound management is to treat clinical infection, not colonisation. Routine antibiotic use for wound colonisation promotes resistance without clinical benefit. The ABPI of 0.9 excludes significant arterial disease, suggesting this is primarily a venous ulcer. Management should focus on compression therapy (ABPI >0.8), wound debridement, and appropriate dressings. Antibiotics (topical or systemic) are only indicated when there are clinical signs of infection.

Reference: NICE CG168 2013 Venous Leg Ulcers; SIGN 120