Barbut Frédéric, Parzybut Bérengère, Boëlle Pierre-Yves, Neyme Denis, Farid Rachida, Kosmann Marie-Jeanne, Luquel Laurence
UHLIN (Unité d'hygiène et de lutte contre les infections nosocomiales), Hôpital Saint-Antoine, AP-HP, Paris (75).
Presse Med. 2006 May;35(5 Pt 1):769-78. doi: 10.1016/s0755-4982(06)74688-7.
To determine the prevalence of pressure sores, their risk factors, and the responsible microbial agents in an acute-care hospital and to evaluate their management.
A prevalence survey was conducted from 5 July through 9 July 2004. Investigators completed a standardized questionnaire for each hospitalized patient, including demographic data (age, sex, previous hospitalizations, etc.) and Braden scale risk factors (sensory perception, humidity, activity, mobility, nutrition, and friction and shear). Two experts in skin care detected pressure sores by physical examination of the patients. Each pressure sore was swabbed and inoculated on selective media. Management was evaluated by reviewing the clinical charts of each patient with a pressure sore.
The study included 535 adult patients (aged 59 +/- 19 years): 75 ulcer sores were observed in 37 patients (prevalence=6.9%). Stage I sores accounted for 24% of the total, stage II for 29%, stage III 31%, and stage IV 16%. The most frequent site was the heel (41%), followed by the sacrum (20%), elbow (11%), back (7%) and ischial tuberosities (7%). Sixty (80%) were acquired while hospitalized. Age-adjusted multivariate analyses found that the risk factors significantly associated with pressure sores were Braden score< or =15 (OR=5.9, 95% CI: 2.4-13.7, p<0.0001) and previous pressure sores (OR=5.0 95% CI: 2.2-11.6, p<0.0001). Eleven sores (24.5%), mostly stage III and IV, were colonized by multiple-drug-resistant bacteria (i.e., methicillin resistant Staphylococcus aureus, extended spectrum beta-lactamase Enterobacteriaceae). Seven (9.3%) of the 75 ulcers were diagnosed only during the survey, by the experts; of the 68 diagnosed before the survey, 57 (83.8%) had been under treatment. Treatment was considered inappropriate according to French guidelines in 31.6% of the cases.
This prospective prevalence study resulted in better awareness of the patients at risk for pressure sores. It also made the recently created mobile geriatrics unit better known within the hospital.
确定一家急症医院中压疮的患病率、危险因素及相关微生物病原体，并评估其管理情况。
于2004年7月5日至7月9日进行了一项患病率调查。调查人员为每位住院患者填写一份标准化问卷，包括人口统计学数据（年龄、性别、既往住院史等）以及Braden量表危险因素（感觉、湿度、活动、移动能力、营养、摩擦与剪切力）。两名皮肤护理专家通过对患者进行体格检查来检测压疮。对每个压疮进行拭子采样并接种于选择性培养基上。通过查阅每位有压疮患者的临床病历对管理情况进行评估。
该研究纳入了535名成年患者（年龄59±19岁）：在37名患者中观察到75处溃疡（患病率=6.9%）。I期压疮占总数的24%，II期占29%，III期占31%，IV期占16%。最常见的部位是足跟（41%），其次是骶骨（20%）、肘部（11%）、背部（7%）和坐骨结节（7%）。60处（80%）是在住院期间发生的。年龄校正后的多因素分析发现，与压疮显著相关的危险因素为Braden评分≤15（比值比=5.9，95%可信区间：2.4 - 13.7，p<0.0001）以及既往有压疮（比值比=5.0，95%可信区间：2.2 - 11.6，p<0.0001）。11处压疮（24.5%），大多为III期和IV期，被多重耐药菌定植（即耐甲氧西林金黄色葡萄球菌、产超广谱β-内酰胺酶肠杆菌科细菌）。75处溃疡中有7处（9.3%）仅在调查期间由专家诊断出来；在调查前已诊断出的68处中，57处（83.8%）已在接受治疗。根据法国指南，31.6%的病例治疗被认为不恰当。
这项前瞻性患病率研究提高了对有压疮风险患者的认识。它也使医院内新设立的移动老年病科为人所知。
