Answer:
Generally, a “healthy” paraplegic with a pressure sore should not develop sepsis if the wound is well debrided and there are no hidden abscess cavities. However, if a patient is elderly, the level of neurologic loss is high or they are otherwise immunocompromised, then the risk of infection and bacteremia, from a pressure sore or other source, is naturally increased.
A study from 1991 reviewed episodes of bacteremia in patients with spinal cord injuries. 18% of episodes were polymicrobial infections. Urinary tract infections (47%), infected pressure sores (19%) and pneumonia (9%) were the most frequent primary infections and sources of bacteremia. Bacteria most frequently isolated from patients with infected pressure areas were anaerobes and Staphylococcus aureus. In another study, it was found that the incidence of decubitus ulcer infection was 1.4 per 1000 ulcer days. An average of 2.4 organisms grew from surface swabs of ulcers, with anaerobes being isolated from 14% of cultures. Notably, the urinary tract appears to be an infrequent source of organisms colonizing pressure sores. In general, antibiotics are not routinely used for treatment of colonization in pressure sores, however in patients with sepsis, deep biopsy specimens can accurately diagnose infection. (Swab specimens and needle aspirates are not accurate because the first method only identifies surface colonizers, whereas needle aspiration underestimates bacterial isolates).
A study from 1998, identifying causes of death in patients with spinal cord injuries found that over a fifty year time period, the leading cause of death was related to the respiratory system; second was death related to the urinary system, and third: heart-disease related deaths. However, the pattern of disease varied over time. In the early decades following injury, urinary deaths ranked first, heart disease deaths second, and respiratory deaths third. In the last two decades of life, respiratory deaths ranked first, heart related deaths second, injury related deaths third, and urinary deaths fourth. Higher mortality risk was associated with higher neurologic level of injury and completeness of spinal cord injury, older age at injury and earlier year of injury. In a separate study, it was found that suicide was the leading cause of death for persons with complete paraplegia and the second leading cause of death in persons with incomplete paraplegia. (This cause of death may have not been included in the first study because it may not have been considered a “medical”cause of death)