Microbiology and Management of Decubitus Ulcers in Children

Abstract

The recent increased recovery of anaerobic bacteria from children has led to greater appreciation of the role anaerobes play in pediatric infections at all body sites, including decubitus ulcers. In studies that employed adequate method for recovery of anaerobes polymicrobial, aerobic, and anaerobic bacteria were isolated from about half of the children with decubitus ulcers. A correlation between the site of the ulcer and the microbial flora of the ulcer was found. The predominant isolates were Staphylococcus aureus, Peptostreptococcus spp., Bacteroides fragilis group, and Pseudomonas aeruginosa. Most of the S. aureus isolates were recovered from ulcers of the hand and the leg. Organisms that resided in the mucous membranes close to the ulcer predominated in the wound next to these areas. Enteric gram-negative rods, Group D enterococcus, and B. fragilis group predominated in ulcers of the buttocks. Group A streptococci, Haemophilus influenzae, pigmented Prevotella and Porphyromonas spp., and Fusobacterium spp. were most frequently recovered in ulcers of the skull. Management of decubitus ulcers should include administration of antimicrobials effective against the polymicrobial bacterial flora according to the anatomic site of the ulcer.