Copeland-Halperin LR, Kaminsky AJ, Bluefeld N, Miraliakbari R, et al.
Journal of wound care. Date of publication 2016 Apr 1;volume 25(4):S4-6, S8-10.
1. J Wound Care. 2016 Apr;25(4):S4-6, S8-10. doi: 10.12968/jowc.2016.25.Sup4.S4.
Sample procurement for cultures of infected wounds: a systematic review.
Copeland-Halperin LR(1), Kaminsky AJ(1), Bluefeld N(1), Miraliakbari R(1)(2).
Author information:
(1)Inova Fairfax Hospital.
(2)Virginia Commonwealth University and Georgetown University.
OBJECTIVE: Identifying the responsible pathogen is required in order to select
optimum antimicrobial therapy for infected wounds, but the best techniques to use
remain the subject of debate. Our aim was to assess the evidence on the value of
wound swabs compared with biopsies.
METHOD: We conducted a systematic literature review with the terms 'wound
infection', 'wound swab', 'wound swab technique', 'wound biopsy', 'wound
culture', 'wound swab comparison', 'Levine swab technique', 'microbiological
technique', 'specimen handling', 'bacterial load', 'perioperative care', 'swab',
and 'culture'. We examined yields in identifying relevant pathogens, summarised
salient features of qualifying studies, and defined knowledge gaps and endpoints
that future studies should address.
RESULTS: Studies have been inconsistent, lacking specificity regarding wound
types, clinical features, and sampling methods. We found moderate quality
evidence that punch biopsies provide qualitative and quantitative information
about the bacterial load and tissue reaction with nearly 100% sensitivity, 90%
specificity and 95% accuracy for predicting wound closure. Biopsies are
relatively invasive, costly, require skilled operators, and potentially
exacerbate infection. Needle aspiration samples a limited portion and may enter
uninfected tissue and extend infection. Wound swabs are minimally invasive,
easier to perform and widely employed in clinical practice, but techniques vary.
In comparative studies, the Levine technique was superior to the Z-swab
techniques, and biopsies were more sensitive for antibiotic-resistant wounds than
Levine or Levine-like swabs, suggesting that swabs may be useful for initial
wound monitoring, but biopsies are preferred when antibiotic resistance is
suspected.
CONCLUSION: The Levine swab is superior to the Z-swab technique and may be useful
for initial wound monitoring, but quantitative biopsies are preferred for
evaluation of antibiotic-resistant wounds and to monitor the response to
treatment. There is limited evidence on the role of wound swabs for detecting
wound colonisation versus infection and the impact of culture-guided therapy on
such clinical outcomes as eradication of infection and accelerated healing.
Future studies should specify patient populations, wound types, sampling
protocols, and outcomes based on culture yield and treatment results, using
rigorous statistical methodology.
DOI: 10.12968/jowc.2016.25.Sup4.S4
PMID: 27068349 [Indexed for MEDLINE]
