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Bacteraemia complicating pressure ulcers

Abstract number: P1825

Espejo E., Andrés M., Morera M.A., Borrallo R.M., Simó M., Bella F.

Objectives: To evaluate the characteristics and prognostic factors of bacteraemia complicating pressure ulcers (BCPU).

Methods: Prospective study of all episodes of significant BCPU, from 1984 to 2006, in a general hospital. Diagnosis was based on positive blood cultures, isolation of the same microorganism in the ulcer culture, and absence of another source of the bacteraemia.

Results: We studied 47 consecutive episodes of BCPU in 44 patients (17 males, 27 females) aged 77±13 yr. The main causative agents were: Staphylococcus aureus (14 cases), Proteus mirabilis (13), Bacteroides sp. (12), Escherichia coli (4), and Pseudomonas aeruginosa (4). Bacteraemia was polimicrobial in 11 cases (23%). Dementia, diabetes, stroke and femur fracture were the most common underlying conditions. The ulcers were already present at admission in 41 cases (87%), but the bacteraemia was hospital-acquired in 17 cases (36%). Multiple ulcers were present in 35 cases. The sacrum was the most common site (38 cases) followed by heels (18) and trochanteric region (16). In 5 cases, the ulcers did not show distinct local signs of infection; in 4 of these episodes, S. aureus was isolated from blood and ulcer cultures. Surgical debridement was performed in 30 cases (64%). Osteomyelitis was documented in 8 cases. Crude mortality was 42% and mortality related to bacteraemia was 21%. Variables associated with a higher mortality were: septic shock (RR 2.1; 95% CI 1.2–3.7) and serum albumin <23 g/l (RR 2.2; 95% CI 1.1–4.5). Surgical debridement was associated with a lower mortality (RR 0.5; 95% CI 0.2–0.9).

Conclusions: BCPU is associated with a high mortality, although many deaths were not directly related to bacteraemia. Polimicrobial bacteraemia is common. Shock and hypoalbuminaemia were adverse prognostic factors, whereas surgical debridement was associated with a lower mortality. Empirical antibiotic therapy should be active against enteric Gram-negative bacilli, S. aureus, and anaerobes including B. fragilis.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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