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SUMMARY Infected ulcerated malignant tumours are often foul smelling and covered with necrotic tissue. We have studied 70 patients with infected ulcers; 30 of the underlying lesions in these patients were carcinoma of the breast, and 19 were a variety of skin cancers. Anaerobes were the predominant organisms isolated from individual ulcers. Of the 179 anaerobes isolated, 37 were Bacteroides asaccharolyticus, 31 each were B melaninogenicus and anaerobic streptococci, 29 B fragilis, and 17 B ureolyticus. Among the facultative organisms Escherichia coli was the commonest and was isolated mainly from patients with carcinoma of the breast. Most infections were mixed, yielding both anaerobes and aerobes and this made interpretation of the role of individual pathogens difficult to assess.Infected ulcers superimposed on malignant lesions are usually characterised by dirty greyish necrotic sloughs, inflammed margins, and very offensive odour. A number of studies on the role of anaerobes in the aetiology of these infections have provided, indirectly through antibiotic trials, an insight into the type of bacteria that may be present in these lesions. ' -6 Although anaerobes together with some facultative bacteria can be isolated from these infected ulcers, it is doubtful whether their presence often leads to bacteraemia and subsequent septicaemia.7 However, the isolation of Bacteroides spp from blood culture, as an initial finding, may be indicative of some deep malignant lesions, particulary carcinoma of the colon.9 As far as we know detailed studies on the bacteriology of infected ulcers superimposed on peripheral malignant lesions have not been reported. In order to provide base line data, we have studied bacteriologically all patients with infected ulcers with underlying malignant lesions admitted to the radiotherapy ward of the hospital. Material and methods SPECIMENSSpecimens were obtained from infected ulcers in 70 consecutive patients admitted to the radiotherapy ward for management of malignant lesions which had become secondarily infected and eroded.Accepted for publication 18 January 1984 Albumin coated cotton wool swabs (Exogen Ltd, Dumbarton Road, Glasgow) were used to obtain wound swabs. They were then broken into Amies transport medium and transported immediately to the anaerobe research laboratory of our hospital. Where feasible, pieces of debrided necrotic tissues were taken into sterile universal bottles and also into steamed cooked meat broth. All specimens were processed within 20 min of taking by a carefully controlled procedure. A set of blood cultures was obtained from the antecubital vein from all patients within the first 24 h of admission. CULTURE All specimens were cultured for anaerobic and aerobic organisms using standard laboratory methods. A set of freshly prepared and prereduced selective and non-selective media was used for isolation of the anaerobes: these included cooked meat broth, blood agar (Oxoid), blood agar plus neomycin (100 ,ug/ml); and BM agar made selective by the addition ...

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