Title : Superinfected eschar in paraplegic patients: Epidemiological, clinical and therapeutic features
Introduction: Secondary infection of eschar in paraplegic patients is a common but serious complication. It increases the burden of care for these patients and puts them at risk of death. The objective of our study was to describe the epidemiological, clinical, and therapeutic characteristics of superinfected eschar in paraplegic patients.
Methods: Retrospective, descriptive study conducted in the Infectious Diseases Department at the Kassab Institute of Orthopedics, including paraplegic patients hospitalized for superinfected bedsores between 2016 and 2022.
Results: We collected 16 cases divided into 13 men and 3 women. The average age was 40 years. Extremes of age [22; 60]. Five patients had diabetes and five were undernourished. Seven patients reported fever with chills. The location of the eschar was sacral (7 cases), trochanteric (8 cases), ischiatic (8 cases), heel (3 cases), and popliteal (1 case). Eschar was Grade III in 10 patients and Grade IV in 6 patients. All patients had local signs of superinfection: inflamed ridges, stemming from pus with a foul odor. Osteitis has been documented in 6 patients. The biological inflammatory syndrome was noted in 10 patients. Seven patients had microbiological documentation of syringe aspiration (n=6), per-op sampling (n=2), and positive blood culture (n=6). Isolated organisms were Escheria coli (n=5), Proteus mirabilis (n=3), klebsiella pneumoniae (n=1), Pseudomonas aeruginosa (n=1), Providencia stuartii (n=1), Proteus vulgaris (n=1), and Enterococcus feacalis (n=1). Surgical treatment was indicated in 6 patients, including 2 cases with osteitis. It was a procedure of excision of superinfected soft tissue. All patients received a broad-spectrum probabilistic antibiotic regimen of piperacillin-tazobactam or imipenem in combination with a glycopeptide which was subsequently adapted for patients with microbiological documentation. The duration of antibiotic therapy was on average 30 days (without osteitis) and 42 days (with osteitis). Local care was provided for all patients. Five patients received VAC therapy. Skin cover with a flap was indicated in 3 patients. The course was marked by complete healing in 6 patients, temporary healing followed by recurrence in 6 cases, and persistence of eschar in 4 cases.
Conclusion: Superinfected eschars are often polymicrobial. Management should be multidisciplinary to cure the infection and promote healing.