{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:46:56Z","timestamp":1791499616538,"version":"4.3.4"},"reference-count":23,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Princess Nourah bint Abdulrahman University Researchers Supporting Project","award":["PNURSP2023R304"],"award-info":[{"award-number":["PNURSP2023R304"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>A pressure ulcer is defined as a skin lesion of ischemic origin, a condition that contributes to morbidity and mortality in patients with spinal cord injuries. The most common complication of ulcers is a bacterial infection. Antimicrobial therapy should be selected with caution for spinal cord injury patients since they have a high risk of developing multidrug-resistant (MDR) infections. The aim of this study was to determine the prevalence of different bacterial pathogens in patients with pressure ulcers admitted with spinal cord injuries. This was a retrospective single-center study that included adult patients aged 18 years and above, admitted with chronic pressure wounds after a spinal cord injury requiring hospitalization between 2015 and 2021. A total of 203 spinal cord injury patients with pressure ulcers were included in the study. Ulcers were commonly infected by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, and they were mostly located in the sacral and gluteal areas. More than half of the bacteria isolated from patients were sensitive to commonly tested antibiotics, while 10% were either MDR- or pan-drug-resistant organisms. Of the MDR bacterial isolates, 25.61% were methicillin-resistant S. aureus, and 17.73% were extended-spectrum beta-lactamase Enterobacteriaceae. The most prevalent bacteria in pressure ulcers of spinal cord injury patients were S. aureus. Other antibiotic-resistant organisms were also isolated from the wounds.<\/jats:p>","DOI":"10.3390\/antibiotics12111587","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T02:41:56Z","timestamp":1698979316000},"page":"1587","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Prevalence of Multidrug-Resistant and ESBL-Producing Bacterial Pathogens in Patients with Chronic Wound Infections and Spinal Cord Injury Admitted to a Tertiary Care Rehabilitation Hospital"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1406-282X","authenticated-orcid":false,"given":"Reem","family":"Binsuwaidan","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Aatif","family":"Khan","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Department of Pathology and Laboratory Medicine, King Abdullah Bin Abdul Aziz University Hospital, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghad H.","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aljoharah M.","family":"Aldusaymani","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noura M.","family":"Almallouhi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alhanouf S.","family":"Alsabti","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajjad","family":"Ali","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Medical Affairs Department, Sultan Bin Abdulaziz Humanitarian City, P.O. Box 64399, Riyadh 11536, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3637-3330","authenticated-orcid":false,"given":"Omar Sufyan","family":"Khan","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Medical Affairs Department, Sultan Bin Abdulaziz Humanitarian City, P.O. Box 64399, Riyadh 11536, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amira M.","family":"Youssef","sequence":"additional","affiliation":[{"name":"Research and Scientific Center, Sultan Bin Abdulaziz Humanitarian City, P.O. Box 64399, Riyadh 11536, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6751-6488","authenticated-orcid":false,"given":"Lina I.","family":"Alnajjar","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.medmal.2018.05.004","article-title":"Management of established pressure ulcer infections in spinal cord injury patients","volume":"49","author":"Dinh","year":"2019","journal-title":"Med. Mal. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1053\/mr.2000.3889","article-title":"Pressure ulcer risk in spinal cord injury: Predictors of ulcer status over 3 years","volume":"81","author":"Garber","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1179\/2045772314Y.0000000234","article-title":"Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know","volume":"38","author":"Dana","year":"2015","journal-title":"J. Spinal Cord Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1038\/sc.2013.91","article-title":"Prevalence, location, grade of pressure ulcers and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: A prospective cohort study","volume":"51","author":"Wyss","year":"2013","journal-title":"Spinal Cord"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2165\/00128071-200203010-00001","article-title":"Impact of increasing antimicrobial resistance on wound management","volume":"3","author":"Filius","year":"2002","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1179\/2045772313Y.0000000093","article-title":"Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends","volume":"36","author":"Kruger","year":"2013","journal-title":"J. Spinal Cord Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Norman, G., Dumville, J.C., Moore, Z.E., Tanner, J., Christie, J., and Goto, S. Antibiotics and antiseptics for pressure ulcers. Cochrane Database Syst. Rev., 2016.","DOI":"10.1002\/14651858.CD011586"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1007\/s00248-016-0867-9","article-title":"Bacterial contribution in chronicity of wounds","volume":"73","author":"Rahim","year":"2017","journal-title":"Microb. Ecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice Guidelines for the diagnosis and management of skin and soft tissue infections: 2014 Update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1038\/sj.sc.3101568","article-title":"Bacteriological investigation of infected pressure ulcers in spinal cord-injured patients and impact on antibiotic therapy","volume":"42","author":"Heym","year":"2004","journal-title":"Spinal Cord"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.ajic.2012.06.006","article-title":"Prevention of methicillin-resistant Staphylococcus aureus infections in spinal cord injury units","volume":"41","author":"Evans","year":"2013","journal-title":"Am. J. Infect. Control"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1128\/CMR.14.2.244-269.2001","article-title":"Wound microbiology and associated approaches to wound management","volume":"14","author":"Bowler","year":"2001","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ejpb.2017.10.004","article-title":"A biocompatible sodium alginate\/povidone iodine film enhances wound healing","volume":"122","author":"Summa","year":"2018","journal-title":"Eur. J. Pharm. Biopharm."},{"key":"ref_14","first-page":"36","article-title":"Understanding antimicrobial resistance and antimicrobial stewardship in wound management","volume":"16","author":"Ousey","year":"2020","journal-title":"Wounds UK"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/WON.0000000000000281","article-title":"Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System","volume":"43","author":"Edsberg","year":"2016","journal-title":"J. Wound Ostomy Cont. Nurs. Off. Publ. Wound Ostomy Cont. Nurses Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/sc.2017.96","article-title":"Predictors of pressure ulcer incidence following traumatic spinal cord injury: A secondary analysis of a prospective longitudinal study","volume":"56","author":"Brienza","year":"2018","journal-title":"Spinal Cord"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Prang, P., Schuld, C., Rupp, R., Hensel, C., and Weidner, N. (2021). Influence of patient isolation due to colonization with multidrug-resistant organisms on functional recovery after spinal cord injury. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0249295"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ijso.2020.12.010","article-title":"Prevalence of multidrug resistance bacterial isolates from infected wound patients in Dhaka, Bangladesh: A cross-sectional study","volume":"28","author":"Alam","year":"2021","journal-title":"Int. J. Surg. Open"},{"key":"ref_19","first-page":"681","article-title":"What makes wounds chronic","volume":"100","author":"Goldberg","year":"2020","journal-title":"Surg. Clin."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Puca, V., Marulli, R.Z., Grande, R., Vitale, I., Niro, A., Molinaro, G., Prezioso, S., Muraro, R., and Di Giovanni, P. (2021). Microbial Species isolated from infected wounds and antimicrobial resistance analysis: Data emerging from a three-years retrospective study. Antibiotics, 10.","DOI":"10.3390\/antibiotics10101162"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s13756-022-01160-5","article-title":"Utilising cumulative antibiogram data to enhance antibiotic stewardship capacity in the Cape Coast Teaching Hospital, Ghana","volume":"11","author":"Dakorah","year":"2022","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"dlab060","DOI":"10.1093\/jacamr\/dlab060","article-title":"The antibiogram: Key considerations for its development and utilization","volume":"3","author":"Truong","year":"2021","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1128\/CMR.00096-12","article-title":"\u03b2-Lactamase production in key gram-negative pathogen isolates from the Arabian Peninsula","volume":"26","author":"Zowawi","year":"2013","journal-title":"Clin. Microbiol. Rev."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/11\/1587\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:16:17Z","timestamp":1760130977000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/11\/1587"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,2]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["antibiotics12111587"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12111587","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,2]]}}}