Microbiology of Pressure Ulcers: A Systematic Review
Abstract
Pressure ulcers are complex wounds frequently complicated by infection. This review aims to characterize the distribution of microorganisms in pressure ulcers and secondarily to assess heterogeneity across studies and compare yields between invasive (biopsies) and noninvasive (swabs/irrigation-aspiration) sampling techniques with implications for antimicrobial management. PubMed, Embase, and the Cochrane Library were searched up to 1 January 2025. Original research articles reporting microbiological data from pressure ulcers were included. Studies were excluded if data were incomplete, combined with other wound types, or derived from non-ulcer sampling sites. Risk of bias was assessed using Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) V2, ROBINS-E, and RoB 2 frameworks. Data were synthesized descriptively and statistically. Twenty-eight studies (1,473 patients, 1,682 pressure ulcers, and 4,231 microbial isolates) were included. The most frequently isolated microorganisms were Staphylococcus aureus (39.7% of ulcers), Corynebacterium spp. (28.8%), Escherichia coli (23.1%), Proteus spp. (23.1%), Streptococcus spp. (22.7%), coagulase-negative Staphylococcus (21.6%), Enterococcus spp. (20.7%), Pseudomonas spp. (17.8%), and Bacteroides spp. (16.0%). On average, 2.5 isolates were reported per ulcer (range: 0.5-4.8). Significant heterogeneity was observed across studies for nearly all major organisms (global heterogeneity: χ² = 1958.4, df = 405, p Providencia…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,473 participants or records.
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