Bacterial Flora in the Genital Area of Patients with Lower Limb Lymphedema

Background: Patients with lymphedema, especially those having genital lymphangiectasia, experience repeated cellulitis; however, the causative bacteria are not detected in most cases. In this study, we investigated the composition of genital bacterial flora in patients with lower limb lymphedema to appropriately treat or prevent repeated cellulitis in these patients. Methods and Results: We examined 47 women with lower limb lymphedema. The average age was 58.4 (range 36-80) years. We performed indocyanine green (ICG) lymphography to confirm the presence of genital lymphedema. For each patient, we swab the skin in the genital area. The swabs were applied to aerobic agar plates, incubated, and evaluated to assess bacterial colonization and resistance to antibiotics. We numbered the patients who held the antibiotic-resistant bacteria, especially methicillin-resistant Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus, and extended spectrum beta-lactamase-producing Enterobacteriaceae. Among the 47 patients enrolled, 30 patients (63.8%) had a history of cellulitis accompanied by lymphedema and 31 patients (66.0%) had genital lymphedema diagnosed by ICG lymphography. Among 47 patients, 43 (91.5%) had at least one bacterial strain. Coryneform bacterial species were most commonly detected in 19 patients. Of 29 patients with a history of cellulitis, 9 had antibiotic-resistant bacteria (31.0%). In contrast, of 18 patients with no history of cellulitis, only 2 had antibiotic-resistant bacteria (11.1%) (p = 0.12). Conclusions: The percentage of patients with drug-resistant bacteria was higher among those with a history of cellulitis than among those without it.