Retrospective analysis of the management of pelvic decubitus ulcers and their outcomes

Therapeutic Advances in Infectious Disease, 2023 · DOI: 10.1177/20499361231196664 · Published: August 7, 2023

Simple Explanation

This study looks at patients with bone infections (osteomyelitis) caused by pressure ulcers who couldn't have surgery to cover the wound with muscle flaps. The goal was to see how different treatments affected their outcomes, specifically if getting long-term antibiotics and wound cleaning (debridement) helped. Researchers reviewed the medical records of 89 patients treated for osteomyelitis related to pressure ulcers. They looked at whether patients received surgical cleaning of the wound and at least six weeks of antibiotics, or other treatments, and then tracked readmission rates and survival. The study found that patients with pressure ulcer-related osteomyelitis had poor outcomes regardless of whether they received extended antibiotics and surgical cleaning or other treatments. This suggests that new strategies are needed for this challenging group of patients.

Study Duration

1 Year

Participants

89 hospitalized patients with pelvic, sacral, or femoral osteomyelitis due to decubitus ulceration

Evidence Level

Retrospective cohort study

Key Findings

1
Patients with decubitus-related osteomyelitis who did not undergo myocutaneous flapping had high rates of hospital readmission.
2
There was no significant difference in outcomes between patients receiving debridement plus ⩾6 weeks of antibiotics and patients receiving other therapy.
3
A trend toward decreased mortality with debridement and longer antibiotics failed to reach statistical significance.

Research Summary

This retrospective study analyzed outcomes of patients with decubitus ulcer-related osteomyelitis who were not candidates for myocutaneous flapping. The study compared outcomes between patients treated with debridement and extended antibiotics (⩾6 weeks) versus other therapies. The study concluded that patients with decubitus ulcer-related osteomyelitis who did not undergo myocutaneous flapping are at high risk for adverse outcomes irrespective of treatment strategy.

Practical Implications

Need for Prospective Studies

Prospective studies are needed to assess best practice strategies for management of patients with decubitus ulcers and osteomyelitis.

Systematic Approach to Diagnosis and Management

There is likely a role for a systematic approach to diagnosis, staging, and management in the inpatient setting.

Multidisciplinary Care

Emphasizes the need for extensive social, nursing, and therapy support needed during the transition into the outpatient care setting.

Study Limitations

1
The retrospective design of the study.
2
The populations examined in this study did not undergo myocutaneous flapping, and the underlying medical and psychosocial reasons for lack of flapping eligibility are possible confounding variables.
3
Uncertainty regarding the chronicity of infection.

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