Bacterial colonization of pressure ulcers: assessment of risk for bloodstream infection and impact on patient outcomes
Bacterial colonization of pressure ulcers: assessment of risk for bloodstream infection and impact on patient outcomes
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DOI：
10.1016/j.jhin.2012.11.008
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发表时间：
2013-04-01
影响因子：
6.9
通讯作者：
Diogo Filho, A.
中科院分区：
文献类型：
--
作者：
Braga, I. A.;Pirett, C. C. N. S.;Diogo Filho, A.
背景资料：压疮（PU）是住院患者、卫生专业人员和社会面临的一个主要问题。目的：评估医院内PU作为多重耐药微生物（MDRO）的储存库、菌血症的危险因素和预后不良的预测因子的影响。方法：一项在三级急诊大学教学医院住院超过48小时的II期或以上PU患者的前瞻性队列研究，2005年4月至2005年12月和2009年8月至2010年4月进行了评估潜在和/或多重耐药医院病原体的定殖/感染。其中，76.5%（111/145）的PU被S.金黄色葡萄球菌（20.7%）、革兰氏阴性杆菌（32.5%）或两者（46.8%），且大多数为MDRO（64.8%）。50.5%（56/111）的患者检出菌血症。溃疡被认为是53.6%（30/56）的菌血症的可能来源。既往使用抗生素（P = 0.04）和感染伤口（P < 0.001）是与血流感染独立相关的变量，也与较高的30天死亡率相关;后者的危险因素包括入住ICU结论：我们的研究结果表明，除了作为一个主要的水库MDRO，PU患者构成了一个高风险的人群菌血症与不良的结果。广谱抗生素和伤口感染是导致患者菌血症和死亡的独立因素。(C)2012年，卫生保健感染协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Pressure ulcers (PUs) represent a major problem for hospitalized patients, health professionals and society.Aim: To evaluate the impact of in-hospital PUs as a reservoir of multidrug-resistant organisms (MDROs), risk factor for bacteraemia and predictor of poor prognosis.Methods: A prospective cohort study of patients with stage II or greater PUs hospitalized in a tertiary acute care university teaching hospital for more than 48 h was performed to evaluate colonization/infection by potential and/or multi-resistant hospital pathogens from April to December 2005 and from August 2009 to April 2010.Findings: A total of 145 patients with stage II or greater PUs were included. Of these, 76.5% (111/145) had PUs colonized and/or infected with either S. aureus (20.7%), Gram-negative bacilli (32.5%), or both (46.8%) and most were MDROs (64.8%). Bacteraemia was detected in 50.5% (56/111) of the patients. The ulcers were considered to be the probable source of bacteraemia in 53.6% (30/56) of the episodes. Prior administration of antibiotics (P = 0.04) and infected wound (P < 0.001) were the variables independently associated with bloodstream infection as well as associated with a higher 30-day mortality rate; risk factors for the latter included hospitalization in ICU (P = 0.03) and mechanical ventilation use (P = 0.05).Conclusions: Our results suggest that besides being a major reservoir of MDROs, patients with PUs constitute a high-risk population for bacteraemia with a poor outcome. Broad-spectrum antibiotics and infected wound were independent factors predisposing patients to both bacteraemia and death. (C) 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.