Skin Physiology and its Microbiome as Factors Associated with the Recurrence of Pressure Injuries

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> Preventing recurrent pressure injuries (RPIs) is one of the important challenges faced in healthcare, but the risk factors of RPIs have not been fully revealed. This study aims to explore factors associated with RPIs, by focusing on skin physiology and its microbiome as local factors crucial for the health of healed tissue after pressure injury healing. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> This prospective observational study was conducted in a long-term care facility in Japan with patients whose PIs had healed within 1 month. Skin physiology was evaluated by stratum corneum (SC) hydration, pH, and transepidermal water loss. Skin bacteria was collected by tape stripping, followed by 16S ribosomal RNA-based metagenomics analysis. These parameters were evaluated every two weeks over a period of six weeks. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 30 patients were included in this study, and 8 patients (26.7%) had an RPI within 6 weeks. In this study, significantly lower SC hydration and a higher rate of Staphylococcus species on the healed site were found in the RPI group. </jats:p></jats:sec><jats:sec><jats:title>Discussion:</jats:title><jats:p> A high rate of RPIs (about one in four) points out the necessity of a further care strategy on the healed PIs. Lower skin hydration and/or the increase in Staphylococcus bacteria may have a potential to be used as a biomarker for the prediction of RPIs, or may be an intervention point for the prevention of RPIs by, for example, skin cleansing with moisturizing care. </jats:p></jats:sec>

Association of Skin Microbiome with the Onset and Recurrence of Pressure Injury in Bedridden Elderly People

“…Our previous studies [ 59 , 62 ] have found that the skin residential microbiome composition in bedridden elderly people is far different from that in ambulatory elderly people and healthy young ones. The major feature of the skin residential microbiome composition change among bedridden elderly people is the remarkable decreased ratio of Cutibacterium spp.…”

“…The outermost layer is often keratinized, and lipids and fatty acids such as ceramide and cholesterol exist around the stratum corneum, with part of them exposed on the skin surface. In the epidermis, 40–50% of water is contained, and the pH of the skin surface is 4 to 5, which is weakly acidic [ 52 , 58 , 59 , 60 ]. As the skin is anatomically and physiologically different from the mucosal tissues in the oral cavity and intestinal tract, the composition of the residential microbiome in the skin is completely different from that in the mucosal tissues [ 52 , 61 ].…”

“…Thus, it is necessary to clarify what bacteria are frequently detected before and after the onset of a pressure injury. It is well-known that pressure injuries in bedridden elderly people often recur [ 59 ]. Therefore, we investigated the frequency of the onset of recurrent pressure injuries, the physiological condition of the skin at the recurrent pressure injury lesion sites, and the bacteria that are frequently present in bedridden elderly people who have once suffered from the same condition before [ 59 ].…”

“…It is well-known that pressure injuries in bedridden elderly people often recur [ 59 ]. Therefore, we investigated the frequency of the onset of recurrent pressure injuries, the physiological condition of the skin at the recurrent pressure injury lesion sites, and the bacteria that are frequently present in bedridden elderly people who have once suffered from the same condition before [ 59 ]. In total, 30 bedridden elderly who were admitted to a medical facility and who had completely recovered from a pressure injury within 1 month as regards skin physiology, composition of the skin residential microbiome, and the presence or absence of a recurrent pressure injury for 6 weeks were assessed.…”

“…The affected individuals had lower water contents in the stratum corneum than the nonaffected individuals, while the abundance ratio of Staphylococcus spp. was found to be significantly higher in the composition of the skin microbiome [ 59 ].…”