Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the preoperative assessment of osteomyelitis.

Perry, Catherine; Pearson, Richard L.; Miller, G A

doi:10.2106/00004623-199173050-00014

Cited by 131 publications

(74 citation statements)

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“…Consequently, debate and controversy continue regarding the type of sample required to provide the most meaningful data, the superiority of one sampling procedure compared with another in terms of microbial recovery (116,188,211,214), and the relevance of wound cleansing prior to sampling (98). The lack of consensus regarding the correct way to prepare and sample a wound is a point of concern within the wound care profession, and results generated by the microbiology laboratory may be misinterpreted and encourage inappropriate treatment.…”

Section: Wound-sampling Methodsmentioning

confidence: 99%

Wound Microbiology and Associated Approaches to Wound Management

2001

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The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds

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Section: Wound-sampling Methodsmentioning

confidence: 99%

Wound Microbiology and Associated Approaches to Wound Management

2001

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“…One limitation of this study is that data on the microbial isolates of the infections were not collected. We rarely take superficial swabs of wounds because they are unreliable culture specimens (51)(52)(53). Thus, most of our cultures were of deep tissue and therefore obtained only for the more severe wounds.…”

Section: Statistical Analysesmentioning

confidence: 99%

Risk Factors for Foot Infections in Individuals With Diabetes

Lavery

Armstrong

Wunderlich³

et al. 2006

Diabetes Care

602

414

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OBJECTIVE -To prospectively determine risk factors for foot infection in a cohort of people with diabetes.RESEARCH DESIGN AND METHODS -We evaluated then followed 1,666 consecutive diabetic patients enrolled in a managed care-based outpatient clinic in a 2-year longitudinal outcomes study. At enrollment, patients underwent a standardized general medical examination and detailed foot assessment and were educated about proper foot care. They were then rescreened at scheduled intervals and also seen promptly if they developed any foot problem.RESULTS -During the evaluation period, 151 (9.1%) patients developed 199 foot infections, all but one involving a wound or penetrating injury. Most patients had infections involving only the soft tissue, but 19.9% had bone culture-proven osteomyelitis. For those who developed a foot infection, compared with those who did not, the risk of hospitalization was 55.7 times greater (95% CI 30.3-102.2; P Ͻ 0.001) and the risk of amputation was 154.5 times greater (58.5-468.5; P Ͻ 0.001). Foot wounds preceded all but one infection. Significant (P Ͻ 0.05) independent risk factors for foot infection from a multivariate analysis included wounds that penetrated to bone (odds ratio 6.7), wounds with a duration Ͼ30 days (4.7), recurrent wounds (2.4), wounds with a traumatic etiology (2.4), and presence of peripheral vascular disease (1.9).CONCLUSIONS -Foot infections occur relatively frequently in individuals with diabetes, almost always follow trauma, and dramatically increase the risk of hospitalization and amputation. Efforts to prevent infections should be targeted at people with traumatic foot wounds, especially those that are chronic, deep, recurrent, or associated with peripheral vascular disease.

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“…Although an elevated ESR and CRP are not diagnostic in itself, they are important indicators of infection and can be a useful baseline in monitoring treatment. Aspiration of nonunion is diagnostic in only 50% to 60% [47] of the cases; however it is the most specific test that yields direct information, which helps in management of these conditions. Imaging studies are often not specific enough to elucidate the cause of nonunion, but form an important part in the pre-surgical planning.…”

Section: Approach To Nonunionsmentioning

confidence: 99%