INTRODUCTION
The term “decubitus ulcer” refers to localized tissue damage in the
skin or subcutaneous tissue resulting from tears and/or friction,
generally together with pressure in areas of bone protrusion. Decubitus
ulcers can develop in any area where bone protrusions are exposed to
pressure, and develop most frequently on the sacrum, coccyx or heels in
supine position, on the hips and ankle joints of patients lying
continuously on the same side, and most frequently on the hips in the
sitting position. [1] They are commonly found on bedridden patients
with comorbidities or on those with limited mobility. The prevalence of
decubitus ulcers has been reported in the range of 4.7–37.1%. [2],
and 11.7% in every 1000 day of hospitalisation in the intensive care
units of hospitals. [3] The same rate is found to be 8.5% in
long-term nursing homes, and has been reported to be up to 33% in
palliative care centers in Turkey [4]. The prevalence of decubitus
ulcers in hospitalized geriatric patients has been reported to be
5.8%
[2]. Decubitus ulcers are a significant cause of morbidity and
mortality, and a source of considerable expense in health expenditures
[3].
It is a significant health problem in long-term bedridden patients,
lowering their quality of life, despite the development of various
preventive and treatment methods [5]. Bacteremia is a frequently
seen complication of decubitus ulcers, although its incidence has yet to
be well defined, and there are scarce studies on the subject [5-7].
Studies investigating the bacteremia associated with decubitus ulcers
are rare, and ulcers mostly could not be documented as the source of
bacteremia [6, 8]. Decubitus ulcers may not be the focus of
bacteremia, since many of the factors that could cause a growth in blood
cultures are already present in this patient group (vascular access,
catheters and tracheostomy, etc.) [3]. The detection of the
causative agent can aid in antibiotic selection and when making the
decision whether or not to treat decubitus ulcer infections. The
causative agent is not always singular, and colonized bacteria are
mostly detected, and there is therefore a lack of consensus whether or
not to administer antibiotics every time a growing agent is detected in
the culture. Systemic antibiotics are suggested for use in the presence
of systemic signs such as a positive blood culture, cellulitis,
fasciitis, osteomyelitis and sepsis, according to the International
Pressure Wound Prevention panel. [9, 10]
The aim in the present study is to assess the frequency of bacteremia of
decubitus ulcer origin as an indicator in decisions to start systemic
antibiotics in patients with decubitus ulcers. The aim in this regard is
to demonstrate how frequent the agent causes a growth in the decubitus
ulcer when deciding to treat it with systemic antibiotics.