University of Modena and Reggio Emilia, Modena, Italy.
Arthritis Care Res (Hoboken). 2012 Feb;64(2):295-7. doi: 10.1002/acr.20673.
Digital ulcers represent one of the most frequent complications of systemic sclerosis (SSc; scleroderma); they are very painful, scarcely responsive to treatment, and often responsible for marked limitations on daily activities, including patient self-care. Infectious complications may severely compromise the outcome of skin lesions in a significant percentage of patients. Numerous pathogens of different origin may be involved, including bacteria from patient endogenous flora. Here we evaluated the possible involvement of fecal pathogens in scleroderma digital ulcers.
Among a series of 82 SSc patients with digital ulcers, we retrospectively analyzed 42 subjects with clinical signs of local bacterial infection. All digital ulcers with suspected infection have been investigated by microbiologic examinations.
Bacterial infection was confirmed in all 42 patients investigated; in particular, Staphylococcus aureus were the most frequently found (50%). Interestingly, 11 (26%) of 42 patients showed digital ulcers infected with intestinal bacteria; specifically, 7 patients were positive for Escherichia coli and 4 for Enterococcus faecalis. Diffuse cutaneous SSc patients were more numerous in this subgroup versus the other 31 patients (Fisher's P = 0.011).
A number of effective measures involving health care personnel and hospital environment are essential in the management of digital ulcers and prevention of infectious complications. In addition, the prevalence of fecal pathogens in one-quarter of cases, never reported previously, suggests an important role of a patient's self-care limitations, mainly during intercurrent home medications. Consequently, methodical education on hand hygiene of both patients and relatives, frequently involved in ulcer medications, is mandatory to avoid such deleterious complications.
手指溃疡是系统性硬皮病（SSc；硬皮症）最常见的并发症之一；它们非常疼痛，对治疗反应不佳，并且经常导致日常活动（包括患者自我护理）受到严重限制。在很大比例的患者中，感染并发症可能严重影响皮肤损伤的结果。不同来源的许多病原体可能涉及其中，包括来自患者内源性菌群的细菌。在这里，我们评估了粪便病原体在硬皮病手指溃疡中的可能作用。
在一系列 82 例患有手指溃疡的 SSc 患者中，我们回顾性分析了 42 例具有局部细菌感染临床体征的患者。所有疑似感染的手指溃疡均进行了微生物学检查。
在所有 42 例接受检查的患者中均确认了细菌感染；特别地，金黄色葡萄球菌是最常发现的（50%）。有趣的是，在 42 例患者中，有 11 例（26%）显示手指溃疡感染了肠道细菌；具体而言，7 例患者对大肠杆菌呈阳性，4 例对粪肠球菌呈阳性。与其他 31 例患者相比，弥漫性皮肤 SSc 患者在该亚组中更多（Fisher's P = 0.011）。
涉及医护人员和医院环境的一些有效措施对于管理手指溃疡和预防感染并发症至关重要。此外，四分之一从未报道过的粪便病原体的流行率表明患者自我护理限制的重要作用，主要发生在间发性家庭用药期间。因此，对经常参与溃疡治疗的患者和亲属进行手部卫生的有系统教育是强制性的，以避免此类有害的并发症。
