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

Abstract

Background Pressure ulcers (PUs) are injuries resulting from ischaemia caused by prolonged compression or shear forces on the skin, adjacent tissues and bones. Advanced stages of PUs are associated with infectious complications and constitute a major clinical challenge, with high social and economic impacts in health care. Goals This study aims to identify and describe the relationship between PU risk factors, stages and anatomical locations, and the relevance of microbial cohabitation and biofilm growth. Methods The narrative review method to advocating a critical and objective analysis of the current knowledge on the topic was performed. Indexed databases and direct consultation to specialized and high‐impact journals on the subject were used to extract relevant information, guided by co‐authors. The Medical Subject Headings of pressure ulcer (or injury), biofilms, infection and other analogues terms were used. Results Development of PUs and consequent infection depends on several direct and indirect risk factors, including cutaneous/PU microbiome, microclimate and behavioural factors. Infected PUs are polymicrobial and characterized by biofilm‐associated infection, phenotypic hypervariability of species and inherent resistance to antimicrobials. The different stages and anatomical locations also play an important role in their colonization. The prevention and monitoring of PUs remain crucial for avoiding the emergence of systemic infections and reducing health care–associated costs, improve the quality of life of patients and reduce the mortality‐associated infected PUs.

Retrospective Study of Decubitus Ulcer in Hospitalized Patients

“…Decubitus ulcers with symptoms of osteomyelitis can be given antibiotics and it is recommended based on the results of culture examinations and antibiotic sensitivity tests, given at the Inpatient Installation of RSUD dr. Moewardi Surakarta, among others, ceftriaxone, levofloxacin, ciprofloxacin, metronidazole, cefixime and meropenem. 16 Severity of decubitus ulcers are divided into 4 stages. Stage 1 decubitus ulcers are if the depth of the ulcer reaches the epidermal layer only, stage 2 decubitus ulcers are if the depth of the ulcer reaches the dermis layer, stage 3 decubitus ulcers are if the ulcer depth reaches the dermis of subcutis layer and stage 4 decubitus ulcers if the depth of the ulcer reaches a deeper layer, namely to muscle, fascia or bone.…”

“…Complications of decubitus ulcers such as periostitis, osteomyelitis, sinus formation, sepsis and even death can occur if the ulcer is not handled properly. 16,20 Debridement is removal of necrotic tissue or dead tissue in the wound which aims to accelerate the wound healing process and the formation of granulation tissue and prevent sepsis. Several types of debridement include enzymatic (an agent which is directly applied to decubitus ulcers), mechanical debridement (removing necrotic tissue using irrigation, hydrotherapy, wet to dry dressing and abrasion techniques) and surgical debridement, which is removing all necrotic tissue using a scalpel or scissors.…”

Current research on fungi in chronic wounds

“…During ulcer formation, inflammatory cells produce reactive oxygen species and lead to extracellular matrix damage ( Mihai, et al, 2018 ). Advanced stages of pressure ulcers are polymicrobial and linked with biofilm-associated infection, and phenotypic hypervariability of species, including fungi and inherent resistance to antimicrobials, constitutes a major clinical challenge ( Gomes, et al, 2022 ).…”

Evolution of the urinary microbiota in spinal cord injury patients with decubitus ulcer: A snapshot study

“…Six PU stages are established by the National pressure injury advisory panel (NPIAP) depending on the gravity and the PU evolution 2 . The prevalence of PUs varies from 7% to 23% in European countries, and between 3.4% and 32.4% worldwide 1–3 . PUs progress to life‐threatening complications in 21%–58% of cases, including 27% of wounds recurrence 4 .…”

“…Pressure ulcers (PU) are unrelieved injuries, caused by sustained compression of the soft tissue bordering the bones. 1 Six PU stages are established by the National pressure injury advisory panel (NPIAP) depending on the gravity and the PU evolution. 2 The prevalence of PUs varies from 7% to 23% in European countries, and between 3.4% and 32.4% worldwide.…”