Squamous cell carcinoma arising from an ischial pressure ulcer initially suspected to be necrotizing soft tissue infection: A case report

BackgroundPressure ulcers are the most common complications in bedridden patients or those with spinal cord injuries. Marjolin's ulcer refers to a malignant transformation arising from burn scars or chronic nonhealing wounds—such as pressure ulcers—over many years. Squamous cell carcinoma is the major histopathologic type of Marjolin's ulcer, and the gold standard for diagnosis is tissue biopsy. Medical professionals may have difficulty distinguishing pressure ulcers from Marjolin's ulcer, especially when the latter presents with invasive infections. Thus, malignant transformations arising from pressure ulcers are frequently overlooked. Herein, we describe a case of squamous cell carcinoma arising from pressure ulcers on the left ischium, which was initially identified as a necrotizing soft tissue infection.Case reportA 59-year-old paraplegic patient presented with stage 3 left ischial pressure ulcer, which involves full-thickness skin loss and extends into deep subcutaneous tissue, and arrived at our hospital with suspected sepsis. Upon physical examination, the patient presented with fever and shivering. Initial examination and imaging findings revealed the presence of necrotizing soft tissue infections. Three weeks later, rapid increase in granulation in the deep part of the ulcer was observed. Samples from multiples ulcer sites were collected for tissue biopsy. Finally, histological examination revealed well-differentiated squamous cell carcinoma. The patient received radiation therapy and chemotherapy and died 11 months after the diagnosis.ConclusionMalignant transformations arising from pressure ulcers may closely resemble pressure ulcer infections. In these cases, tissue biopsies should be performed during primary care for the infection to exclude malignant transformations.     

The value of frozen section biopsy in diagnosing necrotizing fasciitis: proposal of a new grading system

Goals and objectivesNecrotizing fasciitis is a serious disease entity, with only limited pathognomic features.PurposeIn necrotizing fasciitis a rapid diagnosis is necessary in order to reduce morbidity and mortality. In this study the investigation focused on specific features in the frozen section biopsy for diagnosing necrotizing fasciitis.MethodsA total of ten patients are described with final pathological examination of resected tissue.ResultsA new grading system is suggested for frozen section biopsy in patients with necrotizing fasciitis. In the herein reported study it was found that granulocytes were present in both the frozen section biopsy and in the definitive paraffin coupes, in the subcutis and fascia layer.ConclusionFrozen section biopsy could be useful in diagnosing necrotizing fasciitis.     

Post-surgical zygomycotic necrotizing subcutaneous infection caused by Absidia corymbifera

Necrotizing infections of the skin and subcutaneous tissue are usually bacterial in origin. Rarely, fungi of the class Zygomycetes, which cause deep mycoses, may be responsible for acute necrotizing infections of these areas. Several local and systemic predisposing factors have been associated with such acute necrotizing infections. Surgical debridement and amphotericin B remain the mainstay of treatment. In this report we describe a patient with post-surgical necrotizing subcutaneous infection caused by Absidia corymbifera, 2 weeks following appendectomy. Successful management with surgical debridement, topical amphotericin B and oral potassium iodide is reported.     

Necrotizing subcutaneous infection by Streptococcus agalactiae

Necrotizing soft tissue infections constitute some of the most potentially threatening infections that may be acquired in the community or in the hospital milieu as they are associated with a high mortality rate. In most cases they are produced by Streptococcus pyogenes. We report a case of a necrotizing soft tissue infection caused by Streptococcus agalactiae (group B beta hemolytic streptococcus) that involved the leg of an elderly man with chronic lymphatic leukemia and diabetes mellitus. The lesions notably improved after initiating intravenous antibiotic treatment with amoxicillin-clavunate and clindamycin.     

Location-dependent depth and undermining formation of pressure ulcers

Aim of the studyWe examined the location-specific properties of pressure ulcers, focusing on depth and undermining formation, which are often unfavorable factors for ulcer healing.MethodsWe conducted a retrospective observational study of 2 independent databases on pressure ulcers. Databases from a 200-bed hospital (database A) and a 300-bed hospital (database B) were collected during different time periods. Relationships between ulcer location, ulcer depth, and undermining formation were analyzed. All pressure ulcers were accurately diagnosed and classified according to their locations.ResultsA total of 282 pressure ulcers in 189 patients from database A and 232 pressure ulcers in 154 patients from database B were analyzed. It was found that pressure ulcers primarily developed over the sacrum. Ratio of stages III and IV pressure ulcers was high in pressure ulcers of the foot, ankle, and crus on the lower leg. Among the deep pressure ulcers, undermining formation was frequently observed on the greater trochanter, ilium, and sacrum. In contrast, pressure ulcers of the foot, ankle, and crus did not exhibit undermining formation.ConclusionOur results revealed marked differences in pressure ulcer properties depending on their location. Factors affecting depth and undermining of pressure ulcers appear to be related to anatomical and physical properties of the bone and subcutaneous tissue.     

[Translated article] Epidemiologic Profile of the Main Bacterial Sexually Transmitted Infections During the SARS-CoV-2 Pandemic

Background and objectiveThe COVID-19 pandemic brought about social changes in 2020 and 2021. The aim of this study was to evaluate the epidemiologic profiles of the main sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonorrhea, and syphilis) diagnosed during this period and compare them to findings from previous years.Material and methodsDrawing on data from Hospital General Universitario in Valencia, Spain, we recorded the number of chlamydia, gonorrhea, and syphilis cases diagnosed monthly by multiplex polymerase chain reaction (PCR) in 2018–2021 and the number of PCR-confirmed SARS-CoV-2 cases diagnosed monthly in 2020–2021. We also collected clinical and demographic information on all patients diagnosed with STIs during the years studied.ResultsThe total number of STIs diagnosed increased from 570 in 2018–2019 to 664 in 2020–2021. PCR positivity rates were similar in the 2 periods, but the incidence rates were higher during the pandemic. The chronologic correlation between SARS-CoV-2 and STI positivity was negative. Mean age at diagnosis was 29.64 years (95% CI, 19.33–41.14 years) for chlamydia, 30.86 years (95% CI, 20.24–42.45 years) for gonorrhea, and 37.04 years (95% CI, 26.01–51.00 years) for syphilis. The number of men diagnosed with chlamydia increased by 13.85% (95% CI, 6.39–21.08; p = .0003) during the pandemic.ConclusionsWe observed a negative correlation between SARS-CoV2 infections and STIs during the pandemic and an increase in chlamydia cases among men. STI cases rose during 2020–2021, indicating that they remain a significant problem that needs to be addressed in young and adult populations.     

Comportamiento de las principales infecciones de transmisión sexual bacterianas durante la pandemia por SARS-CoV-2

Introduction and objectiveThe SARS-CoV-2 pandemic brought about social changes in 2020 and 2021. The aim of this study was to evaluate the epidemiologic profiles of the main sexually transmitted infections (STIs) of bacterial origin (chlamydia, gonorrhea, and syphilis) diagnosed during this period and compare them to findings from previous years.Material and methodsDrawing on data from Hospital General Universitario in Valencia, Spain, we recorded the number of chlamydia, gonorrhea, and syphilis cases diagnosed monthly by multiplex PCR in 2018-2021 and the number of PCR-confirmed SARS-CoV-2 cases diagnosed monthly in 2020-2021. We also collected clinical and demographic information on all patients diagnosed with STIs during the years studied.ResultsThe total number of STIs diagnosed increased from 570 in 2018-2019 to 664 in 2020-2021. PCR positivity rates were similar in the 2 periods, but the incidence rates were higher during the pandemic. The chronologic correlation between SARS-CoV-2 and STI positivity was negative. Mean age at diagnosis was 29.64 years (95% CI, 19.33-41.14) for chlamydia, 30.86 years (95% CI, 20.24-42.45) for gonorrhea, and 37.04 years (95% CI, 26.01-51.00) for syphilis. The number of men diagnosed with chlamydia increased by 13.85% (95% CI, 6.39-21.08; P = .0003) during the pandemic.ConclusionsWe observed a negative correlation between SARS-CoV-2 infections and STIs during the pandemic and an increase in chlamydia cases among men. STI cases rose during 2020-2021, indicating that they remain a significant problem that needs to be addressed in young and adult populations.     

Prevalence of pressure ulcers in africa: A systematic review and meta-analysis

BackgroundA recent global review of pressure ulcers contained no studies from Africa.ObjectiveTo identify the prevalence and incidence of pressure ulcers in Africa.Data sourcesBibliographic databases, African specific databases, grey literature.Study eligibility criteriaStudies with prevalence or incidence data of pressure ulcers from Africa since the year 2000.ParticipantsAny age, including children, in any setting, specifically including hospital patients from any clinical area but not restricted to hospital settings.Study appraisal and synthesis methodsHoy score for bias, Joanna Briggs Institute Critical Appraisal Instrument.MethodWe followed the PRISMA guideline for systematic reviews. We searched Embase, Medline, Scopus, CINHAL, Google Scholar, specialist African databases and grey literature for studies reporting incidence or prevalence data.ResultsNineteen studies met the inclusion criteria and were included in the study. Point prevalence rates varied from 3.4% to 18.6% for medical/surgical and other general hospital units with a pooled prevalence of 11%, for grades II-IV 5%. For spinal injury units the pooled prevalence was 44%.Limitationsrestricted to English, French and Arabic.ConclusionPrevalence of pressure ulcers in Africa reported here is similar to figures from a recent review of prevalence in Europe and two recent global reviews of hospitalised patients. Prevalence of pressure ulcers in spinal cord injury patients is similar to figures from a review of developing countries. The reporting of prevalence is lacking in detail in some studies. Studies using an observational design employing physical examination of patients showed higher prevalence than those relying on other methods such as medical notes or databases.Implications of key findingsFurther prevalence and incidence studies are needed in Africa. Reporting of such studies should ensure items in the “Checklist for Prevalence Studies” from Joanna Briggs Institute (or similar well regarded resources) are addressed and the PICOS model and PRISMA guidelines are employed.Systematic review registration numberProspero registration number CRD42020180093     

A protocol for a randomized trial measuring flowmetry in risk areas for pressure ulcer: Hyperoxygenated fatty acids vs olive oil

BackgroundPressure ulcers are a common adverse event in healthcare. To date, no flowmetry studies have been conducted to compare hyperoxygenated fatty acids (HFA) vs. extra-virgin olive oil (EVOO) in alleviating this condition.AimsTo determine and evaluate the effect of the application of HFA vs. EVOO on tissue oxygenation and perfusion in heels under pressure, in healthy persons and in hospitalised patients.DesignTwo-phase experimental study.MethodsPhase 1 will be conducted with healthy subjects, using a randomised, open study design, evaluating an intrasubject control group. Phase 2 will focus on hospitalised subjects, with a randomised, open study group vs. a control group.DiscussionThis Project is undertaken to identify the mechanisms that intervene in the genesis of pressure ulcers and to determine whether there are differences in outcomes between the application of HFA vs. EVOO as a preventive measureThe results of this study are of economic importance (due to the price difference between the products used) and will also impact on usual clinical practice for patients with impaired mobility and liable to suffer from pressure ulcers, by considering an alternative to established preventive measures.     

Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review

AimsThe main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect.BackgroundPressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum.DesignQuantitative systematic review.MethodsData sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms. Study eligibility criteria: Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication. Participants: patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion.ResultsThirteen studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies.ConclusionsThere is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation.Prospero idPROSPERO International prospective register of systematic reviews: CRD42017071459.     

Fulminant group A streptococcal necrotizing fasciitis: clinical and pathologic findings in 7 patients

BACKGROUND: Necrotizing fasciitis is a rapidly progressive soft tissue infection with high morbidity and mortality rates. Examination of deep incisional biopsy specimens can provide prompt diagnosis and improve survival. We describe 7 patients with necrotizing fasciitis caused by group A Streptococcus species. OBJECTIVE: Our purpose was to describe the unique dermatopathology and clinical features in 7 patients with necrotizing fasciitis caused by group A Streptococcus. METHODS: We conducted a retrospective review. RESULTS: The average age of the patients was 47 years. Fasciitis occurred on an extremity in all cases. All 5 patients with streptococcal toxic shock syndrome died of their disease. The histopathologic findings from early fascial disease revealed superficial epidermal necrosis, edema, and hemorrhage with few inflammatory cells, whereas clinically advanced, necrotic skin lesions revealed diffuse necrosis, thrombosis, neutrophilia, and numerous gram-positive diplococci. CONCLUSIONS: Patients with clinical features of necrotizing fasciitis should have a deep incisional biopsy specimen obtained from the central area of ecchymotic, necrotic plaques to confirm the diagnosis. Immediate surgical intervention is necessary to reduce the morbidity and mortality rates associated with necrotizing fasciitis.     

32例麻风继发性溃疡分析

目的：了解我院麻风休养员继发性溃疡情况，以便更好地预防和治疗继发性溃疡。方法：使用继发性溃疡调查表调查32例麻风继发性溃疡患者继发性溃疡患者的病因、性质、部位等情况并取继发性溃疡处的分泌物进行细菌培养及药敏试验。结果：32例麻风继发性溃疡共39个病灶。发病部位：足底33个病灶，小腿和手指各3个病灶。溃疡分型：复杂性溃疡灶35个（89.74%），单纯性溃疡灶4个（10.26%）。溃疡原因：灼烫伤引起3个溃疡灶，压力性损伤引起36个溃疡灶。溃疡灶的细菌感染情况：26个病灶无细菌感染，13个存在细菌感染（33.3%)，菌种及药敏情况分别为:金黄色葡萄球菌6株，仅对药物利福平敏感；铜绿假单胞菌4株，对药物庆大霉素、头孢他啶、妥布霉素、环丙沙星、左氧氟沙星、阿米卡星均敏感；奇异变形杆菌、普通变形杆菌、大肠埃希菌各1株，均对头孢他啶、阿米卡星敏感。结论：本地区麻风继发性溃疡以足底溃疡、复杂性溃疡为主，受伤原因以压力性损伤引起为主，感染病原菌以金黄色葡萄球菌为主。     

Lessons learned from patients with spinal cord injury in managing pressure ulcers: A qualitative study

ObjectivesTo explore how individuals with spinal cord injury self-manage the prevention and treatment of pressure ulcers and to provide insight into experiences with self-management support.DesignQualitative study using semi-structured interview and a deductive thematic analysis.SettingCommunity.ParticipantsTwelve of the 14 participating adults with a spinal cord injury had experience with pressure ulcers, and eight of these had a current pressure ulcer.ResultsRespondents suggested to tailor treatment of pressure ulcers to patients’ individual wishes and capabilities of patients. Patients and caregivers need to be aware of the importance of determining the cause of pressure ulcers to prevent deterioration. Patients often depend on informal caregivers for follow-up and prevention, and healthcare professionals in non-SCI specialties often lack the knowledge needed to manage pressure ulcers in this specific patient group. Tailored education and peer support are important for patients to set boundaries, be assertive, and cultivate a positive attitude when dealing with pressure ulcers. It is difficult to combine treatment of severe pressure ulcers and preventive measures with work roles. Managing the social impact of pressure ulcers requires more coordination with caregivers.ConclusionsTo support self-management of pressure ulcers in patients with a spinal cord injury, they must find out which preventive measures and treatments suit them best. Healthcare professionals play an important role in the self-management of pressure ulcers and can help patients deal with the emotional and social impact of pressure ulcers. To know patient's needs and tailor their education, healthcare professionals of non SCI organizations need to have knowledge of pressure ulcers management of this specific patient group.     

Percutaneous flexor tenotomy for preventing and treating toe ulcers in people with diabetes mellitus

IntroductionThe purpose was to examine the effectiveness of flexor tenotomy in a modified technique to prevent and heal neuropathic and neuroischaemic pressure ulcers on the tip of the toe in claw- or hammer-toe deformities in people with diabetes.Patients and methodsA consequetive 4 years series of 38 patients was retrospectively studied. Percutaneous tenotomy on the superficial and deep flexor tendons was performed in 65 toes through a small transverse plantar stab incision just proximal to the web level. There were 16 (42%) patients with 27 ulcerated toes and 22 (58%) patients with 38 toes with impending ulceration. Ten patients had neuropathic ulcers and six patients had neuro-ischaemic ulcers. Sixteen patients (42%) had macrovascular disease. Ten (26%) had proliferative rethinopathy, 7 (18%) macroalbuminuria and 18 (47%) microalbuminuria.ResultsAll surgical incisions healed uneventfully. Twenty-five (93%) of the toe ulcers healed in median 21 days (range 7–224 days). Three patients had recurrence of the ulcer. There were no infections in the incisions or toe amputations. No patients treated with preventive tenotomy experienced toe ulceration. No complications were recorded in neuro-ischaemic ulcers. During the follow up period of median 31 months (range 2–48 months) 33 other ulcers were recorded in 18 patients (47%). One of these developed a transfer ulceration under the adjacent metatarso-phalangeal joint and another had a late pressure ulcer on a neighbouring toe. The other 31 ulcers were not related to ulcers treated with tenotomy.ConclusionTenotomy is a simple, safe and effective procedure for preventing and treating distal plantar neuropathic toe ulcers in claw toe or hammer toe deformities in people with diabetes with or without serious co-morbidity. The results suggest that tenotomy should be considered also in neuroischaemic ulcers.     

Bacterial sexually transmitted infections

Worldwide, the incidence of bacterial sexually transmitted infections (STIs) has shown a significant increase in recent years. In Germany, this circumstance is reflected by a rise in the number of reported syphilis cases. There has also been an uptick in the incidence of non‐notifiable STIs such as gonorrhea and infections caused by Chlamydia trachomatis and Mycoplasma genitalium. A key factor in the spread of these infections is their varied clinical presentation, which includes urogenital, pharyngeal and rectal involvement as well as a large number of asymptomatic cases. New real‐time multiplex PCR methods allow for rapid and targeted detection of STI pathogens. The most common bacterial STI is urogenital chlamydial infection caused by serovars D–K, which affects young adults in particular. Lymphogranuloma venereum (LGV) caused by L serovars often presents as chlamydial proctitis. In recent years, Neisseria (N.) gonorrhoeae has shown a significant development of resistance, with high‐level monoresistance and multiresistance to antibiotics commonly used for treatment. It is therefore imperative that sensitivity testing of N. gonorrhoeae be performed in addition to nucleic acid amplification tests (NAATs). Increased drug resistance has also been observed for Mycoplasma genitalium, a fact that complicates treatment.     

Negative pressure wound therapy with instillation and dwell time in the wound management of necrotizing fasciitis

ObjectiveRecent literature has shown that negative pressure wound therapy with instillation and dwell time (NPWTi-d) is a valid method of managing complex wounds and gained increasingly wider interest due in part to the increasing complexity of wounds. The purpose of this case study was to obtain information on the profile of NPWTi-d in necrotizing fasciitis patients, investigate the role it play in wound bed preparation, length of hospital stay and number of debridement operations.MethodsNPWTi-d has been used in patients with necrotizing fasciitis with either normal saline or Prontosan® solution and complete the treatment were involved in the present study. Following aggressive surgical debridement, NPWTi-d was initiated by instilling solution with a set dwell time of 5–10 min, followed by continuous NPWT of ?125 mm Hg for 3–5 h. The system was changed on a 3–5 days schedule until sufficient granulation tissue was evident. Patients received systemic antibiotics and underwent wound debridement as indicated. Data of wound bed preparation, length of hospital stay, duration of NPWTi-d therapy, number of surgical interventions were collected retrospectively from patient medical records.ResultsA total of 32 patients with diagnosis of necrotizing fasciitis received NPWTi-d were included. Granulation tissue was found to be sufficient in 9–16 days. The mean duration of NPWTi-d therapy was 12.5 days prior to wound closure by split-thickness autograft (n = 21), suture (n = 9), or flap transplantation (n = 2).Patients received NPWTi-d treatment over a period of 8–16 days. The mean length of hospitalization was 22.8 days. All wounds were successfully closed and no recurrence of infection or adverse event was observed during NPWTi-d treatment.ConclusionIn these patients, NPWTi-d facilitates wound cleansing and wound bed preparation and offers the clinician an additional tool for the management of necrotizing fasciitis. Further well designed prospective investigations with low risk of bias are needed to confirm these findings in the future work.     

Investigation of the prevalence of pressure ulcers and patient-related risk factors in hospitals in the province of Erzurum: A cross-sectional study

BackgroundPressure ulcers are a significant health care problem all across the world due to their associated high mortality and morbidity rates and high health care costs. The prevalence of pressure ulcers serves as one of the most important indicators of the quality of nursing care.Study aimThis study aims to determine the prevalence of pressure ulcers and patient-related risk factors in inpatients receiving treatment in the province of Erzurum, located in the eastern part of Turkey.DesignThis is a cross-sectional study.Participantswhich included 832 inpatients hospitalized for at least 24 h after admission in five hospitals in the province of Erzurum. All of the study patients were 18 years of age or older and agreed to participate in the research. Patients hospitalized in the obstetric, emergency, and pediatric clinics were excluded from the study (due to the low probability of pressure ulcers in these clinics).InstrumentsFor the collection of data, the “Introductory Information Form” was used to learn the socio-demographic and clinical characteristics of the patients, and the “Braden Risk Assessment Scale” was used to determine the risk of pressure ulcers. The stage of the pressure ulcers of the patients was determined according to the classification of the National Pressure Ulcer Advisory Panel (NPUAP).MethodsSince the study was planned as a point prevalence study, research data were gathered by the researchers and interviewers on a single day designated for each hospital during the first week of October 2016.ResultsAmong the patients included in the study, 53.1% were male, mean age was 56.62 ± 17.95, 57.2% were treated in internal clinics, and the mean hospital stay was 9.02 ± 13.36 days. In terms of the patients' risk of pressure ulcers, it was determined that 28% were at risk. The overall prevalence of pressure ulcers was calculated to be 12.7% (for stages I-IV), with the overall prevalence decreasing by 6.7% when the patients with stage-I were excluded. Furthermore, it was found that 48.3% of the pressure ulcers were stage-I, and that the sacral region (37.3%) was the most affected region. According to the logistic regression analysis conducted to determine the factors, along with their weights, that affect the development of pressure ulcers, the age of the patient, the duration of the hospital stay, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to have an impact (p < 0.05).ConclusionIn this study, the prevalence of pressure ulcers was calculated to be 12.7%, with the highest prevalence found in intensive care clinics (35.3%). The age of the patient, the duration of the hospital stays, the presence of incontinence, albumin level problems, and a Braden score below 17 were found to be effective in the development of pressure ulcers.     

A new concept: ‘Relative position between the external force and the bony prominence’ explains location-specific occurrence of superficial injury over an undermining lesion

Aim

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. Although the external forces and bony prominences differ depending on ulcer location, the way in which these anatomical differences affect pressure ulcer development is not well studied.

Sex-specific differences in prevention and treatment of institutional-acquired pressure ulcers in hospitals and nursing homes

IntroductionGender and/or sex have a major impact on staying healthy, becoming ill, or care dependent. Differences between men and women have been described for socioeconomic positions, health behaviors, courses and severities of diseases and mortality rates. Consequently, sex and/or gender need to be adequately taken into account while developing and implementing evidence-based healthcare. Evidence regarding differences between men and women in pressure ulcer care is limited. Our research aim was to measure possible differences between male and female hospital patients and nursing home residents in prevention and treatment of institutional-acquired pressure ulcers.MethodsA secondary data analysis was conducted including data sets collected in nursing homes and hospitals in Germany annually from 2001 to 2016. Relevant variables were compared according to biological sex (men/woman).ResultsThe study included 38,655 nursing home residents (mean age 85.4 years women, 77.3 years men) and 58,760 hospital patients (mean age 66.7 years women, 63.4 years men). More women were underweight and at pressure ulcer risk in both settings. The proportion of institutional-acquired pressure ulcers was higher for men in hospitals. Slightly more men had a PU category 2 to 4 (OR 0.87, 95% CI 0.76 to 0.99) in nursing homes or developed an institutional-acquired pressure ulcers category 2 to 4 in both settings (OR 0.85, 95% CI 0.76 to 0.95). Special mattresses were more often used by women at PU risk. More men with an institutional-acquired pressure ulcer in hospitals received counseling of relatives (OR 0.53, 95% CI 0.39 to 0.72).ConclusionAlthough slightly more men had institutional-acquired pressure ulcers than women, overall differences regarding pressure ulcer occurrence were minor. Gender and/or sex can rather not be considered as an independent risk factor for pressure ulcer development and differences regarding pressure ulcer prevention interventions seem to be minor.