Factors Associated With Treatment Failure of Infected Pressure Sores
Factors Associated With Treatment Failure of Infected Pressure Sores
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DOI：
10.1097/sla.0000000000001497
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发表时间：
2016-08-01
影响因子：
9
通讯作者：
Uckay, Ilker
中科院分区：
文献类型：
--
作者：
Jugun, Kheeldass;Richard, Jean-Christophe;Uckay, Ilker
目的：在这项研究中，我们评估了与感染性压疮复发相关的跨学科手术和医疗参数。背景：在已发表的文献中，关于感染性压疮治疗结果相关因素的报道很少。我们对因感染性压疮或植入物住院的脊柱损伤成人进行了单中心回顾，结果：我们发现31例患者（52例骨髓炎）70处病变，中位随访时间为2.7年（范围：4个月至19年）。抗生素治疗的中位持续时间为6周，其中1周为肠外抗生素治疗。治疗后44例感染性溃疡（63%）出现临床复发，平均间隔时间为1年。在86%的复发病例中，培养物产生了与前一次不同的微生物。通过多变量分析，以下因素与复发无显著相关性：手术干预次数（风险比0.9，95%置信区间0.5-1.5）;骨髓炎（风险比1.5; 0.7-3.1）;免疫抑制;既往骶骨感染和总（或仅肠外）抗生素使用时间。抗生素治疗12周的患者（卡方检验; P = 0.90）。结论：在感染性压疮患者中，临床复发发生在几乎三分之二的病变中，但只有14%具有相同的病原体。手术清创次数、皮瓣使用次数或抗生素治疗时间与复发无关，提示复发是由其他院外因素引起的再感染引起的。
Objective: In this study, we assess interdisciplinary surgical and medical parameters associated to recurrences of infected pressure ulcers.Background: There is a little in the published literature regarding factors associated with the outcome of treatment of infected pressure ulcers.Methods: We undertook a single-center review of spinal injured adults hospitalized for an infected pressure ulcer or implant-free osteomyelitis and reviewed the literature on this topic from 1990-2015.Results: We found 70 lesions in 31 patients (52 with osteomyelitis) who had a median follow-up of 2.7 years (range, 4 months to 19 years). The median duration of antibiotic therapy was 6 weeks, of which 1 week was parenteral. Clinical recurrence after treatment was noted in 44 infected ulcers (63%), after a median interval of 1 year. In 86% of these recurrences, cultures yielded a different organism than the preceding episode. By multivariate analyses, the following factors were not significantly related to recurrence: number of surgical interventions (hazard ratio 0.9, 95% confidence interval 0.5-1.5); osteomyelitis (hazard ratio 1.5; 0.7-3.1); immune suppression; prior sacral infections, and duration of total (or just parenteral) antibiotic sue. Patients with antibiotic treatment for 12 weeks (chi(2) test; P = 0.90).Conclusions: In patients with infected pressure ulcers, clinical recurrence occurs in almost two-thirds of lesions, but in only 14% with the same pathogen(s). The number of surgical debridements, flap use, or duration of antibiotic therapy was not associated with recurrence, suggesting recurrences are caused by reinfections caused by other extrahospital factors.