• Kheeldass Jugun, Jean-Christophe Richard, Benjamin A Lipsky, Benjamin Kressmann, Brigitte Pittet-Cuenod, Domizio Suvà, Ali Modarressi, and Ilker Uçkay.
• *Division of Plastic, Reconstructive, and Aesthetic Surgery Service, Geneva University Hospitals, Geneva, Switzerland†Orthopedic Surgery Service, Geneva University Hospitals, Geneva, Switzerland‡Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland§Division of Medical Sciences, University of Oxford, Oxford, UK.
• Ann. Surg. 2016 Aug 1; 264 (2): 399-403.

ObjectiveIn this study, we assess interdisciplinary surgical and medical parameters associated to recurrences of infected pressure ulcers.BackgroundThere is a little in the published literature regarding factors associated with the outcome of treatment of infected pressure ulcers.MethodsWe undertook a single-center review of spinal injured adults hospitalized for an infected pressure ulcer or implant-free osteomyelitis and reviewed the literature on this topic from 1990-2015.ResultsWe found 70 lesions in 31 patients (52 with osteomyelitis) who had a median follow-up of 2.7 years (range, 4 months to 19 years). The median duration of antibiotic therapy was 6 weeks, of which 1 week was parenteral. Clinical recurrence after treatment was noted in 44 infected ulcers (63%), after a median interval of 1 year. In 86% of these recurrences, cultures yielded a different organism than the preceding episode. By multivariate analyses, the following factors were not significantly related to recurrence: number of surgical interventions (hazard ratio 0.9, 95% confidence interval 0.5-1.5); osteomyelitis (hazard ratio 1.5; 0.7-3.1); immune suppression; prior sacral infections, and duration of total (or just parenteral) antibiotic sue. Patients with antibiotic treatment for <6 weeks had the same failure rate as those with as >12 weeks (χ test; P = 0.90).ConclusionsIn patients with infected pressure ulcers, clinical recurrence occurs in almost two-thirds of lesions, but in only 14% with the same pathogen(s). The number of surgical debridements, flap use, or duration of antibiotic therapy was not associated with recurrence, suggesting recurrences are caused by reinfections caused by other extrahospital factors.

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