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Infectious complications of pressure ulcers

Imad Tleyjeh, MD, MSc
Dan Berlowitz, MD, MPH
Larry M Baddour, MD, FIDSA
Section Editor
Daniel J Sexton, MD
Deputy Editor
Allyson Bloom, MD


Pressure ulcers are localized areas of tissue necrosis that tend to develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time [1]. They are a significant problem in critically ill patients, the elderly, and in persons with spinal cord injury (SCI).

Pressure ulcers cause pain, decrease quality of life, and lead to significant morbidity and prolonged hospital stays, in part due to complicating infection. Infected pressure ulcers are a common problem, occurring in 4 to 6 percent of nursing home patients in two series [1,2].

The infectious complications of pressure ulcers will be reviewed here. The epidemiology, pathogenesis, clinical manifestations, staging, prevention and treatment of noninfected pressure ulcers are discussed separately. (See "Epidemiology, pathogenesis and risk assessment of pressure ulcers" and "Prevention of pressure ulcers" and "Clinical staging and management of pressure-induced injury".)

Pressure ulcers that occur in the feet of patients with severe neuropathy and/or vascular insufficiency, often due to diabetes mellitus, are discussed separately. (See "Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities".)


Local factors that contribute to infection of pressure sores include breaks in the integrity of the skin barrier, pressure-induced changes, and contamination from contiguous dirty areas. The majority of pressure ulcers in SCI patients develop in areas adjacent to the ischium, sacrum, and greater trochanter. (See "Epidemiology, pathogenesis and risk assessment of pressure ulcers".)


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Literature review current through: Feb 2017. | This topic last updated: Nov 13, 2015.
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