The Brazilian Journal of Infectious Diseases The Brazilian Journal of Infectious Diseases
Braz J Infect Dis 2017;21:171-5 - Vol. 21 Num.2 DOI: 10.1016/j.bjid.2016.11.007
Brief communication
Pressure ulcer as a reservoir of multiresistant Gram-negative bacilli: risk factors for colonization and development of bacteremia
Iolanda A. Bragaa, Cristiane S. Britob,, , Augusto Diogo Filhoa, Paulo P. Gontijo Filhob, Rosineide M. Ribasb
a Universidade Federal de Uberlândia, Hospital de Clínicas, Uberlândia, MG, Brazil
b Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Uberlândia, MG, Brazil
Received 31 March 2016, Accepted 16 November 2016
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.

Keywords
Pressure ulcer, Gram-negative bacilli, Colonization, Bacteremia
Braz J Infect Dis 2017;21:171-5 - Vol. 21 Num.2 DOI: 10.1016/j.bjid.2016.11.007