In this study, 30 patients with non-healing, infected leg ulcers were included of whom 26 (86.7%) were males and 4 (13.3%) were females. Of these, 8 (26.7%) were diabetics, 12 (40%) were post-traumatic, 6 (20%) were varicose ulcers and 4 (13.3%) were burns wounds. Thirty age and sex- matched controls were enrolled in the study that were being treated with topical antibiotics but were not responding to therapy. Of the controls, 26 (86.7%) were males, 49 (13.3%) were females. Of these, 8 (26.7%) were diabetics, 12 (40%) were post-traumatic, 6 (20%) were varicose ulcers and 4 (13.3%) were burns wounds. The culture done on Day 1 among the study group isolated Staphylococcus aureus 14 (46.7%) of which 10 (71.4%) were Methicillin Resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa 8 (26.7%), Citrobacter koserii 4 (13.3%), Proteus vulgaris 2 (6.7%) and Enterobacter spp 2 (6.7%), among the 30 patients.
The antibiogram revealed that most of the organisms were multi-drug resistant. Staphylococcus aureus isolates were resistant to Penicillin (85.7%), Clindamycin (85.7%), Cotrimoxazole (71.4%) and Cefoxitin (57.1%). Among the Gram-negative bacilli, all strains (100%) of Pseudomonas aeruginosa were resistant to Amoxiclav, Ceftizoxime, Cotrimoxazole, Ofloxacin. All Citrobacter koserii, Proteus vulgaris and Enterobacter spp strains (100%) were resistant to Amoxicillin-Clavulanic acid, Aztreonam, Cotrimoxazole and Ofloxacin.
As shown in , subsequent cultures of the study group who were using Aloe vera dressings showed no growth by the fifth day in 10 (33.3%) cases, seventh day in another 16 (53.3%) and ninth day in two (6.7%) of the remaining four cases while in two (6.7%) cases there was no decrease in the bacterial count and there was bacterial growth in these cases on Day 11 also. All the other 28 patients showed no bacterial growth by Day 11 Growth of bacteria in study group is decreased from 100% (30 cases) to 6.7% (2 cases) in day 11 with P<0.001.
Bacterial growth in control & study group on alternate days of sampling
The culture done on Day 1 among the control group also isolated the same group of organisms which were more sensitive to the commonly used antibiotics. Subsequent cultures of the control group who were using topical antibiotics did not show any decrease in the bacterial growth on Days 3, 5, 7, 9 and 11. The same organisms with identical pattern of antibiogram were isolated.
shows a leg ulcer with inflammation and debris and depicts the same ulcer after a period of 11 days during which Aloe vera was topically applied showing clinical improvement.
Case 03, Day 11 Image of leg ulcer with inflammation and debris showing clinical improvement after 10 days.
Similarly, shows an image of a leg ulcer with oedema and discharge without granulation tissue and shows clinical improvement after 11 days with healthy granulation tissue and decrease in oedema following regular topical application of Aloe vera gel.
Case 06, Day 11 Image of leg ulcer with oedema and discharge without granulation tissue showing clinical improvement after 10 days with healthy granulation tissue and decrease in oedema
Note: Growth of bacteria in study group is decreased from 100% (30 cases) to 6.7%(2 cases) in day 11 with P<0.001** while the growth of bacteria is remains constant in control
On the other hand, shows an image of a leg ulcer from the patient in the control group and there is no clinical improvement after 11 days of application of topical antibiotics and alternate day dressing as shown in .
Control 11, Day 11 Image of leg ulcer from a patient in the control group showing no clinical improvement after 10 days of application of topical antibiotics and alternate day dressing