In our studies, varicose veins specimen stage 4 (CEAP classification) revealed presence of bacterial isolates in 40 %, whereas controls taken from healthy cadaveric organ donors contained live bacteria in only 4 % (Table 9.3). Disinfected skin specimens from the sites of varicectomy showed presence of microbes in 4 %. The dominant isolates from vein specimens were Staphylococci, preponderantly coagulase negative; however, in a few cases Enterococcus faecium was also detected. Staphylococci were highly sensitive to antibiotics except of penicillin (Table 9.4). Thirty-three percent of isolates were methicillin resistant. The 16sRNA was detected in 69 % of specimens, evidently higher than the percentage of live bacterial cells.

Bacterial culture on the Hemoline plates revealed microbes migrating from the outer aspect of varices, adjacent fat but not muscles (Fig. 9.1).

Bacterial phenotypes on ulcer exudate remain similar to those identified on adjacent skin; however, the numerical distribution of strains becomes different (Table 9.5). Strains of Gram-negative Bacilli dominate over others, and the number of colonies is tripled (Tables 9.6 and 9.7). This may be the result of more favorable environmental conditions on the granulation tissue for some strains or less favorable for others. Interestingly, bacteria cultured from the ulcer surface revealed increasing resistance to antibiotics compared with the flora taken from normal leg skin (Tables 9.8 and 9.9).