Clinical evaluation with long-term follow-up of patients with pressure ulcers in one Swedish county.

OBJECTIVE: To conduct a screening, skin examination and risk assessment of patients with pressure ulcers (PUs) in one Swedish county (inpatient, primary and community care) with follow-up after six months to investigate ulcer healing, frequency of amputation and mortality rate linked to preventive measures. METHOD: The methodology recommended by the European Pressure Ulcer Advisory Panel was used. Screening, risk assessment and skin examination were performed during March 2017. The modified Norton scale was used to assess PU risk, with a score of ≤20 indicating presence of risk. A research questionnaire was used to document prevention and treatment. Follow-up was performed after six months, during September 2017. The same research questionnaire was used to capture the current situation of the patients, including ulcer healing, frequency of amputation, and mortality rate. RESULTS: Screening covered 464 patients: 303 hospitalised, 68 in community care, and 93 in primary care. A total of 110 patients-55 at risk of PU and 55 with PUs, the majority of which were category 2-4 PUs-were included in the study. At follow-up, 67% were treated in community care, 32% in primary care, and 1% in hospital. Mortality rate for patients with PUs was 44%. Of the remaining 31 patients, 17 had unhealed PUs, 10 had healed PUs, two had undergone amputation, and complete follow-up data was missing in the remaining two patients. CONCLUSION: These results reflect the complex situation of an aged and frail patient group, including a lack of preventive measures and follow-up routines in community and primary care.

Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy.

The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment.

Bacterial cultures, rapid strep test, and antibiotic treatment in infected hard-to-heal ulcers in primary care.

OBJECTIVE: In-depth studies on antibiotic treatment for patients with hard-to-heal ulcers in primary care are lacking. The present study was undertaken to update the bacteriological spectrum for this patient group and to investigate antibiotic treatment. A further aim was to investigate the potential of a rapid strep test to find group A streptococci (GAS) causing ulcer infection. DESIGN: A prospective study from August 2009 to August 2010. SETTING: Blekinge Wound Healing Center. SUBJECTS: Patients with clinical signs of infected hard-to-heal ulcers of any etiology. MAIN OUTCOME MEASURES: A bacterial culture and a rapid strep test were taken from every ulcer to capture the bacteriological spectrum. Antibiotic treatment before and during the study period was measured. RESULTS: Forty-one patients with 49 infected ulcers were recruited. Staphylococcus aureus, found in 68.8% of all cultures, was the most observed species. Group G streptococci (GGS) were found in 12.5%. GAS was found in one case where the rapid strep test was positive. Staphylococcus aureus was found in three patients out of four with clinical signs of erysipelas. Some 59% of the patients were treated with antibiotics before the study period compared with 44% during the study period. CONCLUSION: Antibiotic treatment was largely reduced because of structured wound management. The current bacteriological spectrum showed high rates of GGS and erysipelas caused by Staphylococcus aureus. The rapid strep test was found useful in identifying GAS but we would not recommend its use in the clinical setting due to the low rate of GAS in this patient group.