Abstract
Background: Pressure injuries are a common and devastating complication in spinal cord injured patients, with wound bioburden playing a critical role in healing outcomes. This study evaluated the microbiological profile of pressure injuries in spinal cord injured patients at a Nigerian tertiary centre and assessed its impact on treatment outcomes.
Methods: A retrospective cohort study of 371 spinal cord injured patients who presented with pressure injuries at the National Orthopaedic Hospital Dala, Kano, from January 2019 to June 2026 was conducted. Wound swabs were analysed for microbiological isolates. Treatment modalities included honey dressing following serial debridement, vacuum‑assisted closure and flap coverage. Outcomes assessed included wound healing, complications and predictors of favourable outcome.
Results: The most common pressure injury locations were sacral (38.0%), gluteal (31.5%), occipital (14.8%) and other sites (15.6%). The predominant organisms isolated were Staphylococcus aureus (34.2%), Pseudomonas aeruginosa (28.6%), coliforms (18.9%), Proteus species (10.2%) and mixed growth (8.1%). Multidrug resistance was observed in 31.5% of isolates. Complete wound healing was achieved in 72.2% of patients. Independent predictors of favourable outcome included: absence of diabetes mellitus (adjusted OR 2.8, 95% CI: 1.5-5.2), sacral location (OR 2.4, 95% CI: 1.3-4.5) and flap coverage (OR 3.1, 95% CI: 1.6-6.0).
Conclusions: Pressure injuries in spinal cord injured patients at this Nigerian centre are predominantly colonised by Staphylococcus aureus and Pseudomonas aeruginosa, with significant multidrug resistance. Wound microbiology influences treatment selection and outcomes. Routine microbiological surveillance and rational antibiotic use are essential for optimising pressure injury care.