Bacteriology and Antimicrobial Sensitivity of Isolated Bacteria from Pressure Ulcers After Spinal Cord Injury

Abstract

Background: Infection is a common problem in chronically denuded skin, especially in pressure ulcers (PUs). It is one of the main reasons for delayed wound healing, in addition to morbidity and even mortality after spinal cord injury (SCI). Objectives:The current study aimed at determining the pathogenic microorganisms, as well as their antimicrobial sensitivity, isolated from active PUs in post-rehabilitated cases with SCI. Methods:The current cross sectional study was conducted from January 2015 to January 2016, on 55 outpatients with traumatic SCI and active stage II, III, and IV PUs in the Brain and Spinal Cord Injury Research Center (BASIR), Tehran, Iran. The largest PU in each case was rinsed with sterile saline and deeply sampled with sterile swabs. The cultures were bacteriologically identified and antibiogram was performed. Results:The current study population included 55 cases with a mean age of 32.7 ± 11.5 years, of which 87.3% were male. The sacral region was the most common site (n = 31; 56.4%) for PU, followed by trochanteric area (n = 9; 16.4%). The wound swab culture was positive in 51 patients (92.7%). Majority of the bacteria isolated from smaller lesions of stage II and III PUs was Escherichia coli (E. coli) (P = 0.027), while larger lesions with advanced stage were more commonly colonized with Staphylococcus epidermidis (P = 0.0378). Antimicrobial assessment of the isolated microorganisms revealed multidrug resistant E. coli and staphylococci as the prevailing organisms. Conclusions:Microorganisms invade PUs are multi-drug resistant, and their anti-microbial sensitivity patterns may be quite different from that of normal flora.

Sub epidermal moisture measurement and targetedSSKINbundle interventions, a winning combination for the treatment of early pressure ulcer development

“… 35 Pressure ulcer risk assessment tools are varied and inconsistent in their inclusion of different risk factors, 36 an issue that has prompted substantial research into their reliability and validity. 37 , 38 , 39 , 40 The Braden Scale was selected as it has been shown to have moderate to high validity and reliability among varied patient cohorts including trauma/ICU patients, 40 , 41 , 42 paediatric patients, 43 , 44 long term care patients, 45 , 46 patients with spinal cord injuries, 47 and elderly patients. 48 The inter‐rater reliability of the Braden Scale was substantial in every ward versus not good in orthopaedic and spinal surgery wards for the Norton Scale and not good in the orthopaedic wards for the Waterlow Scale.…”

The skin microbiome of infected pressure ulcers: A review and implications for health professionals

“…19 Some common characteristics and symptoms of this stage of PUs (redness, pain, heat and swelling) indicate the high proliferation of several species of pathogenic agents and communities. 104 The characteristics of pathogenic agents in these PU stages are similar to those in stages II and IV, despite the increase in complexity 105,106 . In a study aimed at investigating the association between the bacterial bioburden and the presence of wound inflammation, the authors found that unstageable and deep tissue PU stages are reservoirs of high bacterial counts and positive biofilm formation.…”