title: Pressure ulcer as a reservoir of multiresistant Gram-negative bacilli: risk factors for colonization and development of bacteremia.
abstract: The purpose of this study was to identify the risk factors that predispose patients who are hospitalized with pressure ulcers (PUs) colonized by Gram-negative bacilli (GNB) to develop bacteremia. In addition, we also detected main phenotypes of resistance in infected and uninfected PUs. A prospective cohort study was conducted at the Clinical Hospital of the Federal University of Uberlândia including patients with Stage II or greater PUs, colonized or not with GNB, from August 2009 to July 2010. Infected ulcers were defined based on clinical signs and on positive evaluation of smears of wound material translated by a ratio of polymorphonuclear cells to epithelial cells ≥2:1, after Giemsa staining. A total of 60 patients with Stage II PUs were included. Of these 83.3% had PUs colonized and/or infected. The frequency of polymicrobial colonization was 74%. Enterobacteriaceae and GNB non-fermenting bacteria were the most frequent isolates of PUs with 44.0% of multiresistant isolates. Among patients who had infected PUs, six developed bacteremia by the same microorganism with a 100% mortality rate. In addition, PUs in hospitalized patients were major reservoir of multiresistant GNB, also a high-risk population for the development of bacteremia with high mortality rates.
authors.affiliation: Universidade Federal de Uberlândia, Hospital de Clínicas, Uberlândia, MG, Brazil.
authors.forename: Iolanda A
authors.initials: IA
authors.lastname: Braga
authors.affiliation: Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Uberlândia, MG, Brazil. Electronic address: cristianebrito_bio@yahoo.com.br.
authors.forename: Cristiane S
authors.initials: CS
authors.lastname: Brito
authors.affiliation: Universidade Federal de Uberlândia, Hospital de Clínicas, Uberlândia, MG, Brazil.
authors.forename: Augusto Diogo
authors.initials: AD
authors.lastname: Filho
authors.affiliation: Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Uberlândia, MG, Brazil.
authors.forename: Paulo P Gontijo
authors.initials: PP
authors.lastname: Filho
authors.affiliation: Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Uberlândia, MG, Brazil.
authors.forename: Rosineide M
authors.initials: RM
authors.lastname: Ribas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology*; D004197:Disease Reservoirs / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000235:genetics*; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D003668:Pressure Ulcer / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Bacteremia; Colonization; Gram-negative bacilli; Pressure ulcer