Infectious complications of pressure ulcers
- Imad Tleyjeh, MD, MSc
Imad Tleyjeh, MD, MSc
- Head, Division of Infectious Diseases
- King Fahd Medical City, Saudi Arabia
- Dan Berlowitz, MD, MPH
Dan Berlowitz, MD, MPH
- Boston University Schools of Public Health and Medicine
- Larry M Baddour, MD, FIDSA, FAHA
Larry M Baddour, MD, FIDSA, FAHA
- Professor of Medicine
- Mayo Clinic College of Medicine
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 . 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-induced skin and soft tissue injury" and "Clinical staging and management of pressure-induced skin and soft tissue 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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