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Pressure ulcer as a reservoir of multiresistant Gram-negative bacilli: risk factors for colonization and development
Iolanda A Braga1, Cristiane S Brito2, Augusto Diogo Filho1
1Universidade Federal de Uberlândia, Hospital de Clínicas, Uberlândia, MG, Brazil.
Abstract:
The purpose of this study was to identify the risk factors that predispose patients who are hospitalized with pressure ulcers (PUs) colonized by Gram-negative bacilli (GNB) to develop bacteremia. In addition, we also detected main phenotypes of resistance in infected and uninfected PUs. A prospective cohort study was conducted at the Clinical Hospital of the Federal University of Uberlândia including patients with Stage II or greater PUs, colonized or not with GNB, from August 2009 to July 2010. Infected ulcers were defined based on clinical signs and on positive evaluation of smears of wound material translated by a ratio of polymorphonuclear cells to epithelial cells ≥2:1, after Giemsa staining. A total of 60 patients with Stage II PUs were included. Of these 83.3% had PUs colonized and/or infected. The frequency of polymicrobial colonization was 74%. Enterobacteriaceae and GNB non-fermenting bacteria were the most frequent isolates of PUs with 44.0% of multiresistant isolates. Among patients who had infected PUs, six developed bacteremia by the same microorganism with a 100% mortality rate. In addition, PUs in hospitalized patients were major reservoir of multiresistant GNB, also a high-risk population for the development of bacteremia with high mortality rates.
Insights
Hospitalized patients with pressure ulcers (PUs) colonized by Gram-negative bacilli (GNB) face high bacteremia risk. Multiresistant GNB in PUs are linked to severe outcomes and 100% mortality in bacteremic patients.
Area of Science:
- Infectious Diseases
- Wound Care
- Microbiology
Background:
- Hospitalized patients with pressure ulcers (PUs) are susceptible to Gram-negative bacilli (GNB) colonization.
- GNB colonization in PUs can lead to severe infections, including bacteremia.
- Understanding risk factors and resistance patterns is crucial for patient management.
Purpose of the Study:
- To identify risk factors for bacteremia in hospitalized patients with GNB-colonized PUs.
- To determine the main antimicrobial resistance phenotypes in infected and uninfected PUs.
- To assess the clinical outcomes of GNB bacteremia originating from PUs.
Main Methods:
- Prospective cohort study involving patients with Stage II or greater PUs.
- Inclusion criteria: GNB colonization or infection.
- Ulcer infection defined by clinical signs and Giemsa-stained smear analysis (polymorphonuclear cells to epithelial cells ratio ≥2:1).
Main Results:
- 83.3% of 60 Stage II PU patients had colonization and/or infection.
- Polymicrobial colonization occurred in 74% of cases.
- Enterobacteriaceae and non-fermenting GNB were common, with 44% multiresistant isolates.
- Six patients developed bacteremia from infected PUs, resulting in 100% mortality.
Conclusions:
- Pressure ulcers in hospitalized patients serve as a reservoir for multiresistant GNB.
- Patients with infected PUs colonized by GNB are at high risk for developing bacteremia.
- Bacteremia originating from PUs carries a significant mortality risk, underscoring the need for effective prevention and treatment strategies.
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