Tedeschi S, Negosanti L, Sgarzani R, Trapani F, Pignanelli S, Battilana M, Capirossi R, Brillanti Ventura D, Giannella M, Bartoletti M, Tumietto F, Cristini F, Viale P, et al.
Clinical microbiology and infection : the official publication of the European Society of Clini.... Date of publication 2017 Dec 1;volume 23(12):943-947.
1. Clin Microbiol Infect. 2017 Dec;23(12):943-947. doi: 10.1016/j.cmi.2017.04.015.
Epub 2017 Apr 19.
Superficial swab versus deep-tissue biopsy for the microbiological diagnosis of
local infection in advanced-stage pressure ulcers of spinal-cord-injured
patients: a prospective study.
Tedeschi S(1), Negosanti L(2), Sgarzani R(3), Trapani F(4), Pignanelli S(5),
Battilana M(2), Capirossi R(2), Brillanti Ventura D(2), Giannella M(4),
Bartoletti M(4), Tumietto F(4), Cristini F(4), Viale P(4).
Author information:
(1)Infectious Disease Unit, Sant'Orsola-Malpighi Teaching Hospital - Alma Mater
Studiorum University of Bologna, Bologna, Italy. Electronic address:
sara.tedeschi@aosp.bo.it.
(2)Montecatone Rehabilitation Institute, Imola, Italy.
(3)Plastic Surgery Unit, AUSL Romagna, Italy.
(4)Infectious Disease Unit, Sant'Orsola-Malpighi Teaching Hospital - Alma Mater
Studiorum University of Bologna, Bologna, Italy.
(5)Laboratory Analysis of Clinical Chemistry and Microbiology, S. Maria della
Scaletta Hospital, Imola, Italy.
OBJECTIVE: To assess the predictive value of superficial ulcer swab culture to
make a microbiological diagnosis of deep wound infections in spinal cord injury
(SCI) patients with advanced-stage pressure ulcers.
METHODS: From July 2011 to February 2014, we performed a prospective,
single-centre study on adult SCI patients undergoing scheduled surgical
debridement and reconstruction for advanced-stage pressure ulcers, at Montecatone
Rehabilitation Institute, a 150-bed hospital dedicated to SCI care. Three
superficial ulcer swabs were preoperatively collected using the Levine technique,
then sent for culture. In surgery, multiple bone and soft-tissue specimens were
taken and sent for culture and histological examination. No antibiotics were
administered before surgery. The results of swabs and intraoperative specimens
were compared.
RESULTS: In all, 116 patients were included, median age 49 years; a majority were
males with post-traumatic paraplegia. According to intraoperative specimen
cultures, the most common micro-organisms were Staphylococcus aureus, Proteus
mirabilis, and Pseudomonas aeruginosa, found in 31, 27, and 16 cases,
respectively. Concordance between superficial swabs and intraoperative specimen
culture was found in only in 25 out of 116 cases (22%). The main reason for
non-concordance was the yielding of different micro-organisms (41 out of 116);
false negatives (swab negative/intraoperative positive) accounted for 31 out of
116 and false positives (swab positive/intraoperative negative) for 19 out of
116. When compared with intraoperative specimens, sensitivity and specificity of
the swab culture were 80% and 54%, respectively.
CONCLUSIONS: Our results confirm that in patients with advanced-stage pressure
ulcers, the cultures of a superficial ulcer swab are not useful in either the
diagnosis of a superinfection or the prediction of the role of involved
micro-organisms.
Copyright © 2017 European Society of Clinical Microbiology and Infectious
Diseases. Published by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.cmi.2017.04.015
PMID: 28433727 [Indexed for MEDLINE]
