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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 (2023)Cite this article

Subjects

Abstract

Study design

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.

Objectives

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.

Setting

University hospital with a spinal cord injury unit.

Methods

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.

Results

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.

Conclusions

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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Fig. 1: Distribution of the primary bacterial colonisation.
Fig. 2: Distribution of the primary bacterial colonisation infection.
Fig. 3: Duration of ulcer healing.

Data availability

Data for this study are available on reasonable request. Please contact the corresponding author for the research data.

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Author information

Authors and Affiliations

  1. Berufsgenossenschaftliche Universitätsklinik Bergmannsheil Bochum gGmbH, Gastroenterology and Hepatology, Bochum, Germany

    Luisa C. Lichtenthäler, Andreas M. Pussin, Wolff Schmiegel & Thorsten Brechmann

  2. Berufsgenossenschaftliche Universitätsklinik Bergmannsheil Bochum gGmbH, Department of General and Trauma Surgery, Spinal Cord Injury Unit, Bochum, Germany

    Mirko Aach & Dennis Grasmücke

  3. Berufsgenossenschaftliche Universitätsklinik Bergmannsheil Bochum gGmbH, Department of General and Trauma Surgery, Bochum, Germany

    Thomas A. Schildhauer

Authors
  1. Luisa C. Lichtenthäler
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  2. Andreas M. Pussin
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  3. Mirko Aach
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  4. Dennis Grasmücke
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  7. Thorsten Brechmann
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Contributions

LCL: Conducting the study, acquisition of data, analysis and interpretation, drafting the manuscript; LCL approved the final manuscript. luisa.lichtenthaeler@t-online.de. AMP: Conducting the study, acquisition of data, analysis and interpretation, revision of the manuscript; Andreas Pussin approved the final manuscript. andreaspussin@gmx.de. TAS: Supervision, revision of the manuscript, support in terms of spinal cord injury and surgery; Thomas Schildhauer approved the final manuscript. thomas.A.Schildhauer@ruhr-uni-bochum.de. MA: Conception and design of the study, supervision, revision of the manuscript, support in terms of spinal cord injury; Mirko Aach approved the final manuscript. mirko.aach@bergmannsheil.de. DG: Data analysis and interpretation, drafting the manuscript; Dennis Grasmücke approved the final manuscript. dennis.grasmuecke@bergmannsheil.de. WS: Supervision, revision of the manuscript, support in terms of gastroenterology; Wolff Schmiegel approved the final manuscript. wolff.schmiegel@rub.de. TB: Conception and design of the study, data analysis and interpretation, supervision, drafting the manuscript; TB approved the final manuscript. thorsten.brechmann@rub.de.

Corresponding author

Correspondence to Thorsten Brechmann.

Ethics declarations

Ethics approval

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.

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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 (2023). https://doi.org/10.1038/s41393-023-00901-6

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