title: Bacterial colonization of pressure ulcers: assessment of risk for bloodstream infection and impact on patient outcomes.
abstract: BACKGROUND
  Pressure ulcers (PUs) represent a major problem for hospitalized patients, health professionals and society.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  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.
authors: Clinical Hospital of the Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil. iobraga2006@yahoo.com.br
authors: I A
authors: IA
authors: Braga
authors: C C N S
authors: CC
authors: Pirett
authors: R M
authors: RM
authors: Ribas
authors: P P
authors: PP
authors: Gontijo Filho
authors: A
authors: A
authors: Diogo Filho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D001419:Bacteria / Q000302:isolation & purification*; D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult