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Abstract：
BACKGROUND: Pressure sores are sometimes refractory to treatment, often due to malnutrition. Small intestinal bacterial overgrowth (SIBO) obstructs absorption in the digestive tract and causes malnutrition. However, little is known about the association between pressure sore wound healing and SIBO. Here, we report a case of a patient with a refractory sacral pressure sore and SIBO.
METHODS: A 66-year-old woman who was spinal cord injured 14 years before visiting our hospital presented with the chief complaint of a sacral pressure sore, 10.0 × 6.5 cm in size, which was refractory to treatment. Physical examination showed abdominal distension and emaciation, with a body mass index of 15. Further examination revealed elevated serum alkaline phosphatase (1260 U/L), bilateral tibial fracture, multiple rib fracture, and osteoporosis. We diagnosed the patient with osteomalacia with vitamin D deficiency. Despite oral supplementation, serum levels of calcium, phosphorous, and vitamin D remained low. Also, despite concentrative wound therapy for the sacral pressure sore by plastic surgeons, no wound healing was achieved. Due to a suspicion of disturbances in nutrient absorption, we performed bacterial examination of collected gastric and duodenal fluid, which showed high numbers of bacteria in gastric content (104 E. coli, 105 Streptococcus species, and 105 Neisseria species) and duodenal content (106 E. coli, 104 Candida glabrata). Therefore, we diagnosed the patient with SIBO and started selective decontamination of the digestive tract using polymyxin B sulfate and amphotericin B. After starting treatment for SIBO, the sacral pressure sore began to heal and was nearly healed after 285 days. The patient\'s serum levels of calcium, phosphorous, vitamin D, and other fat-soluble vitamins also gradually increased after starting treatment for SIBO.
CONCLUSIONS: We report a case of a patient with a refractory sacral pressure sore that healed after starting treatment for SIBO. We conclude that SIBO may be an overlooked cause of malnutrition and poor wound healing in patients with chronic pressure sores.
METHODS: A 66-year-old woman who was spinal cord injured 14 years before visiting our hospital presented with the chief complaint of a sacral pressure sore, 10.0 × 6.5 cm in size, which was refractory to treatment. Physical examination showed abdominal distension and emaciation, with a body mass index of 15. Further examination revealed elevated serum alkaline phosphatase (1260 U/L), bilateral tibial fracture, multiple rib fracture, and osteoporosis. We diagnosed the patient with osteomalacia with vitamin D deficiency. Despite oral supplementation, serum levels of calcium, phosphorous, and vitamin D remained low. Also, despite concentrative wound therapy for the sacral pressure sore by plastic surgeons, no wound healing was achieved. Due to a suspicion of disturbances in nutrient absorption, we performed bacterial examination of collected gastric and duodenal fluid, which showed high numbers of bacteria in gastric content (104 E. coli, 105 Streptococcus species, and 105 Neisseria species) and duodenal content (106 E. coli, 104 Candida glabrata). Therefore, we diagnosed the patient with SIBO and started selective decontamination of the digestive tract using polymyxin B sulfate and amphotericin B. After starting treatment for SIBO, the sacral pressure sore began to heal and was nearly healed after 285 days. The patient\'s serum levels of calcium, phosphorous, vitamin D, and other fat-soluble vitamins also gradually increased after starting treatment for SIBO.
CONCLUSIONS: We report a case of a patient with a refractory sacral pressure sore that healed after starting treatment for SIBO. We conclude that SIBO may be an overlooked cause of malnutrition and poor wound healing in patients with chronic pressure sores.
摘要：
背景：压疮有时难以治疗，往往是由于营养不良。小肠细菌过度生长（SIBO）会阻碍消化道的吸收并导致营养不良。然而,关于压疮伤口愈合和SIBO之间的关联知之甚少。这里,我们报告了一例难治性骶骨压疮和SIBO患者。
方法：一位66岁的女性，在我们医院就诊前14年曾遭受脊髓损伤，主诉为骶骨压疮，尺寸为10.0×6.5厘米，这是难以治疗的。体检显示腹胀消瘦,体重指数为15.进一步检查发现血清碱性磷酸酶升高（1260U/L），双侧胫骨骨折,多发性肋骨骨折,和骨质疏松症。我们诊断患者患有骨软化症伴维生素D缺乏。尽管口服补充，血清钙水平，磷,维生素D仍然很低。此外，尽管整形外科医生对骶骨压疮进行了集中伤口治疗，伤口没有愈合。由于怀疑营养吸收受到干扰，我们对收集的胃和十二指肠液进行了细菌检查，在胃内容物中显示出大量的细菌(104大肠杆菌，105种链球菌，和105种奈瑟菌）和十二指肠含量（106种大肠杆菌，104光滑念珠菌）。因此,我们诊断患者患有SIBO，并开始使用硫酸多粘菌素B和两性霉素B对消化道进行选择性净化。骶骨压疮开始愈合，285天后几乎痊愈。病人的血清钙水平，磷,维生素D,和其他脂溶性维生素也在开始SIBO治疗后逐渐增加。
结论：我们报告了一例难治性骶骨压疮患者，该患者在开始SIBO治疗后愈合。我们得出的结论是，SIBO可能是慢性压疮患者营养不良和伤口愈合不良的原因。
方法：一位66岁的女性，在我们医院就诊前14年曾遭受脊髓损伤，主诉为骶骨压疮，尺寸为10.0×6.5厘米，这是难以治疗的。体检显示腹胀消瘦,体重指数为15.进一步检查发现血清碱性磷酸酶升高（1260U/L），双侧胫骨骨折,多发性肋骨骨折,和骨质疏松症。我们诊断患者患有骨软化症伴维生素D缺乏。尽管口服补充，血清钙水平，磷,维生素D仍然很低。此外，尽管整形外科医生对骶骨压疮进行了集中伤口治疗，伤口没有愈合。由于怀疑营养吸收受到干扰，我们对收集的胃和十二指肠液进行了细菌检查，在胃内容物中显示出大量的细菌(104大肠杆菌，105种链球菌，和105种奈瑟菌）和十二指肠含量（106种大肠杆菌，104光滑念珠菌）。因此,我们诊断患者患有SIBO，并开始使用硫酸多粘菌素B和两性霉素B对消化道进行选择性净化。骶骨压疮开始愈合，285天后几乎痊愈。病人的血清钙水平，磷,维生素D,和其他脂溶性维生素也在开始SIBO治疗后逐渐增加。
结论：我们报告了一例难治性骶骨压疮患者，该患者在开始SIBO治疗后愈合。我们得出的结论是，SIBO可能是慢性压疮患者营养不良和伤口愈合不良的原因。
