Validation of predictive factors for infection in adults with chronic leg ulcers: A prospective longitudinal study

Abstract

Aims and objectives To validate the ability of factors to predict infection in adults with chronic leg ulcers over a 12‐week period. Background Leg ulcers affect ~3% of older adults and are often hard to heal. Infection is a leading contributor for delayed healing, causing delayed wound healing, increased hospitalisation, increased healthcare costs and reduced patient quality of life. The importance of early identification of infection has been highlighted for decades, yet little is known about factors that are associated with increased risk of infection in this specific population. Design A longitudinal, prospective observational study in a single centre. Methods Between August 2017 and May 2018, a total of 65 adults with chronic leg ulcers were prospectively observed for a 12‐week period. Patients were recruited from an outpatient wound clinic at a tertiary hospital in Australia. Data were collected from recruitment (baseline) and each visit (weekly or fortnightly) up until 12 weeks. Descriptive statistics were calculated for all variables. A Cox proportional hazards regression model was used to identify predictive factors for infection. The TRIPOD guidelines for reporting were followed (See Data S1). Results The sample consisted of 65 adults with chronic leg ulcers, and 9.2% of these had their ulcer infected at baseline. Two predictive factors, using walking aids and gout, were found to be significantly related to increased likelihood of developing infection within 12 weeks. Conclusion The present study showed that patients who either used walking aids or were diagnosed with gout were at greater risk of infection compared to those without these factors. Relevance to clinical practice These findings provide new information for clinicians in early identification of patients at risk of infection, and for patients in enhancing their awareness of their own risk.

Antibiotic prescription using a digital decision support system: a register-based study of patients with hard-to-heal ulcers in Sweden

“…Reduced prescription may, in turn, contribute to reducing the general health burden of antibiotic resistance. The proportion of antibiotic prescription seen in both groups in this study was in agreement with earlier studies of infection in hard-to-heal ulcers15–18 supposing neither underprescription nor overprescription. The lower proportion of antibiotic prescription seen when using the DDSS could be due to the fact that patients in the study group had significantly shorter healing time than the patients in the control group.…”

“…One complication in wound management is ulcer infection. Treatment-requiring infection in hard-to-heal ulcers varies from 8% to 27%15–18 in earlier publications, depending on the ulcer aetiology and the underlying diseases of the patient. For diabetic foot ulcers, the presence of treatment-requiring infection is more frequent compared with the whole group of hard-to-heal ulcers.…”

Assessment, management and prevention of chronic wounds in the Australian context: a scoping review

“…Risk factors for infection in chronic leg and foot ulcers included depression, requiring walking aids, a calf-ankle ratio <1.3, larger wound area, and slough 406,407 . However, not all were validated in a small prospective study 408 . A small study found a significant relationship between transcutaneous oxygen pressure (TcpO 2 ) assessment and ulcer healing over 4 weeks 409 , and an evidence implementation study found improved EBP in wound assessment in primary healthcare professionals 410 .…”