Pressure sore infected

Prevention is key in the management of pressure sores. Mild superficial pressure sore infections may be treated with topical antimicrobial agents. Systemic antibiotics are indicated for pressure sores associated with spreading cellulitis, osteomyelitis, or bacteremia. 

Pressure sore infections develop from breaks in skin integrity and contamination from dirty areas of close proximity. Pressure sore infections generally are polymicrobial.39... 

Bacterial colonization of pressure sores is common. Because infection impairs wound healing and may require systemic antimicrobial therapy, the clinician must be able to distinguish it from colonization. Table 70-8 describes the clinical presentation of infected pressure sores. 

Tens of thousands of Americans, including 1 of every 12 persons with spinal cord injury, die each year as a result of complications relating to pressure sores.41 Most complications are infectious. The most common is osteomyelitis, which is present in approximately 38% of infected pressure sores.37 Less frequently, NF, clostridial myonecrosis, and sepsis can occur. 

The goals of therapy for infected pressure sores include resolution of infection, promotion of wound healing, and establishment of effective infection control.38... 

A pressure sore is also called a decubitus ulcer and bed sore. A classification system for pressure sores is presented in Table 47-5. Many factors are thought to predispose patients to the formation of pressure ulcers paralysis, paresis, immobilization, malnutrition, anemia, infection, and advanced age. Four factors thought to be most critical to their formation are pressure, shearing forces, friction, and moisture however, there is still debate as to the exact pathophysiology of pressure sore formation. The areas of highest pressure are generated over the bony prominences. 

Most pressure sores are colonized by bacteria however, bacteria frequently infect healthy tissue. A large variety of aerobic gram-positive and gramnegative bacteria, as well as anaerobes, are frequently isolated. 

See Table 47-4 for systemic treatment of an infected pressure sore. A short, 2-week trial of topical antibiotic (silver sulfadiazine or triple antibiotic) is recommended for a clean ulcer that is not healing or is producing a moderate amount of exudate despite appropriate care. 

Venous thromboembolism Urinary incontinence and infection Pressure sores... 

Pressure sores may occur secondary to poor nursing, incontinence or malnourishment. They may become infected and take months to heal, thus delaying rehabilitation. Pressure sores can be avoided by attention to pressure areas, use of appropriate mattresses and supports and by regular turning of immobile patients (NHS center for Reviews and Dissemination and the Nuffield Institute for Health 1995). 

Silver sulfadiazine is used for prophylaxis and treatment of infected bums, leg ulcers and pressure sores because of its wide antibacterial spectrum (which includes pseudomonads). 

Prevention is the single most important aspect in the management of pressure sores. After a sore develops, successful local care includes a comprehensive approach consisting of relief of pressure, proper cleaning (debridement), disinfection, and appropriate antimicrobial therapy if an infection is present. Good wound care is crucial to successful management. 

Complications of pressure sores are not uncommon and may be life-threatening. Infection is one of the most serious and most frequently encountered complications of pressure ulcers. Bacterial colonization must be differentiated from true bacterial infection. While most pressure sore wounds are colonized, the majority of these eventually heal. When the tissue is infected, there is bacterial invasion of previously healthy tissue. Without treatment, an initial small, localized area of ulceration can progress rapidly to 5 to 6 cm within days. The visible ulcer is just a small portion of the actual wound up to 70% of the total wound is below the skin. A pressure-gradient phenomenon is created by which the wound takes on a conical nature the smallest point is at the skin surface, and the largest portion of the defect is at the base of the ulcer (Fig. 108-1). 

Patients with pressure sores commonly have other medical problems that may mask the typical signs and symptoms of infection. 

With appropriate wound care and antimicrobial therapy, infected pressure sores can heal. A reduction in erythema, warmth, pain, and other signs and symptoms should be seen in 48 to 72 hours. 

Wounds can be classified into acute wounds and chronic wounds. While acute wounds take only a few weeks to heal, chronic wounds require several months to heal completely. Chronic wounds include venous leg ulcers and pressure sores. Wounds are not usually sterile. A wound may bear a level of 100,000 microorganisms per gram of tissue. Beyond this number, the wound may become infected. In some wounds the pathogens may be able to colonise (critical colonisation) and this is considered to be detrimental for wound healing. Wound bacteria can be acquired from the patient s own endogenous flora or from exogenous microbial contamination... 

Neurological exam PR (exclude constipation) Pressure areas (sores/infection) Evidence of pain Visual acuity Hearing... 

Multiple health problems, such as recurrent kidney stones, urinary tract infection, pressure sores, and cardiac and respiratory dysfunction, arise as a result of the loss of sensory and motor functions in regions below the level of the injury (Talac et al. 2004). Pneumonia, pulmonary emboli, and septicemia are the leading causes of death in individuals that survive the initial SCI (Becker et al. 2003). Treatments that reduce autonomic dysfunction and neuropathic pain will significantly improve the quality of life of individuals living with a SCI (Anderson et al. 2002,2007 Vogel et al. 2002). 

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