Retrospective matched case-control study including patients with spinal cord injury who presented with an anus-near pressure injury. Two groups were formed based on the presence of a diverting stoma.
To evaluate the primary microbial colonisation and secondary infection of anus-near pressure injuries depending on the presence of a pre-existing diverting stoma and to investigate the effect on the wound healing.
University hospital with a spinal cord injury unit.
A total of 120 patients who had undergone surgery of an anus-near decubitus stage 3 or 4 were included in a matched-pair cohort study. Matching was realised according to age, gender, body mass index and general condition.
The most common species in both groups was Staphylococcus spp.(45.0%). The only significantly different primary colonisation affected Escherichia coli, that was found in the stoma patients less often (18.3 and 43.3%, p < 0.01). A secondary microbial colonisation occurred in 15.8% and was equally distributed, except for Enterococcus spp. that was present in the stoma group only (6.7%, p < 0.05). The time to complete cure took longer in the stoma group (78.5 versus 57.0 days, p < 0.05) and was associated with a larger ulcer size (25 versus 16 cm2, p < 0.01). After correction for the ulcers’ size, there was no association to outcome parameters such as overall success, healing time or adverse events.
The presence of a diverting stoma alters the microbial flora of an anus-near decubitus slightly without impact on the healing process.
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Data for this study are available on reasonable request. Please contact the corresponding author for the research data.
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The study protocol was approved by the institutional review board of the Ruhr University Bochum [registry number 18-6351] on the basis of the ethical guidelines of the Declaration of Helsinki and its later revisions; informed consent was obtained from all patients before surgery. Informed consent was neither practicable nor necessary for this retrospective study and was exempted by the institutional review board.
The authors declare no competing interests.
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Lichtenthäler, L.C., Pussin, A.M., Aach, M. et al. Minor microbial alterations after faecal diversion do not affect the healing process of anus-near pressure injuries in patients with spinal cord injury - results of a matched case-control study. Spinal Cord 61, 352–358 (2023). https://doi.org/10.1038/s41393-023-00901-6