Management of established pressure ulcer infections in spinal cord injury patients

•Management should be multidisciplinary.•Infection should be differentiated from colonization.•Sampling must be performed in case of clinical infection before antibiotic treatment.•Microbiological diagnosis is essential in the event of bone involvement.•Prolonged antimicrobial therapy is of no value. Pressure ulcers are frequently observed in spinal cord injury (SCI) patients. They can be life-threatening and are a major medico-economic burden. Despite their frequency, their pathophysiology and optimal management are still poorly understood. Most available data comes from non-comparative studies, especially in terms of antimicrobial use. We performed a critical review of the literature and opinions of infectious disease specialists based in a French expert center for this disease. We mainly focused on antimicrobial treatments prescribed in this situation. These infections are usually clinically diagnosed. Microbiological samples are not the gold standard for this assessment. Furthermore, reliable microbiological identification is a major challenge but should help select antimicrobial treatment. Imaging technique could be helpful but cannot replace the physical examination. The choice of antimicrobials must consider the potential ecological collateral damages in this vulnerable population. Antimicrobial therapy should be as short as possible, adapted to the microbiological identification, and must have suitable bioavailability. Management of infected pressure ulcers is a major concern in disabled patients already highly exposed to antimicrobial treatment and multidrug-resistant organisms colonization. Extensive data is required. Les escarres sont fréquentes chez les patients blessés médullaires. Elles sont associées à une importante morbi-mortalité et constituent un fardeau médicoéconomique majeur. Malgré leur fréquence, la physiopathologie et la gestion optimale ne sont toujours pas connues. La plupart des données disponibles proviennent d’études non-comparatives, notamment en ce qui concerne l’utilisation d’antimicrobiens. Nous présentons un examen critique de la littérature et nous focalisons surtout sur les traitements antimicrobiens dans cette situation. Le diagnostic d’infection repose essentiellement sur l’examen clinique car les prélèvements microbiologiques ne sont dans ce cas pas utile. En outre, une identification microbiologique fiable est un défi majeur mais devrait aider à sélectionner un traitement antimicrobien adapté. Les examens d’imagerie