How reliable are cultures of specimens from superficial swabs compared with those of deep tissue in patients with diabetic foot ulcers?

Mutluoğlu, Mesut; Uzun, Günalp; Turhan, Vedat; Görenek, Levent; Ay, Hakan; Lipsky, Benjamin A.

doi:10.1016/j.jdiacomp.2012.03.015

Cited by 52 publications

(45 citation statements)

References 22 publications

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“…Two studies 62,63 have been published since the IDSA, NICE and IWGDF guidelines. Mutluoglu et al 62 assessed the reliability of cultures of superficial swabs by comparing them with cultures of concomitantly obtained deep tissue specimens in patients with DFUs.…”

Section: The Need For Researchmentioning

confidence: 99%

“…Currently available evidence from the main diabetic foot infection guidelines (NICE, 37 IDSA 1,2,36 and the IWGDF 42,56 ) and other studies 62,63 is not sufficiently robust to advise clinicians on the best technique to identify pathogens in DFUs.…”

Section: Introductionmentioning

confidence: 99%

“…) and 8.1% of samples (CODIFI), and different isolates in 6.7% (Mutluoglu et al 62 ) and 13.2% (CODIFI).…”

mentioning

confidence: 98%

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Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Nelson

Wright-Hughes

Brown

et al. 2016

Health Technol Assess

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BackgroundThere is inadequate evidence to advise clinicians on the relative merits of swabbing versus tissue sampling of infected diabetic foot ulcers (DFUs).ObjectivesTo determine (1) concordance between culture results from wound swabs and tissue samples from the same ulcer; (2) whether or not differences in bacterial profiles from swabs and tissue samples are clinically relevant; (3) concordance between results from conventional culture versus polymerase chain reaction (PCR); and (4) prognosis for patients with an infected DFU at 12 months’ follow-up.MethodsThis was a cross-sectional, multicentre study involving patients with diabetes and a foot ulcer that was deemed to be infected by their clinician. Microbiology specimens for culture were taken contemporaneously by swab and by tissue sampling from the same wound. In a substudy, specimens were also processed by PCR. A virtual ‘blinded’ clinical review compared the appropriateness of patients’ initial antibiotic regimens based on the results of swab and tissue specimens. Patients’ case notes were reviewed at 12 months to assess prognosis.ResultsThe main study recruited 400 patients, with 247 patients in the clinical review. There were 12 patients in the PCR study and 299 patients in the prognosis study. Patients’ median age was 63 years (range 26–99 years), their diabetes duration was 15 years (range 2 weeks–57 years), and their index ulcer duration was 1.8 months (range 3 days–12 years). Half of the ulcers were neuropathic and the remainder were ischaemic/neuroischaemic. Tissue results reported more than one pathogen in significantly more specimens than swabs {86.1% vs. 70.1% of patients, 15.9% difference [95% confidence interval (CI) 11.8% to 20.1%], McNemar’sp-value < 0.0001}. The two sampling techniques reported a difference in the identity of pathogens for 58% of patients. The number of pathogens differed in 50.4% of patients. In the clinical review study, clinicians agreed on the need for a change in therapy for 73.3% of patients (considering swab and tissue results separately), but significantly more tissue than swab samples required a change in therapy. Compared with traditional culture, the PCR technique reported additional pathogens for both swab and tissue samples in six (50%) patients and reported the same pathogens in four (33.3%) patients and different pathogens in two (16.7%) patients. The estimated healing rate was 44.5% (95% CI 38.9% to 50.1%). At 12 months post sampling, 45 (15.1%) patients had died, 52 (17.4%) patients had a lower-extremity ipsilateral amputation and 18 (6.0%) patients had revascularisation surgery.LimitationsWe did not investigate the potential impact of microbiological information on care. We cannot determine if the improved information yield from tissue sampling is attributable to sample collection, sample handling, processing or reporting.ConclusionsTissue sampling reported both more pathogens and more organisms overall than swabbing. Both techniques missed some organisms, with tissue sampling missing fewer than swabbing. Results from tissue sampling more frequently led to a (virtual) recommended change in therapy. Long-term prognosis for patients with an infected foot ulcer was poor.Future workResearch is needed to determine the effect of sampling/processing techniques on clinical outcomes and antibiotic stewardship.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: The Need For Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Concordance in diabetic foot ulceration: a cross-sectional study of agreement between wound swabbing and tissue sampling in infected ulcers

Nelson

Wright-Hughes

Brown

et al. 2016

Health Technol Assess

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“…This method is not reliable for predicting the definitive pathogens. For the accurate diagnosis samples for culture should be aspirated from an abscess or curettage from the ulcer base following superficial debride- (15,16). Definitive diagnosis of osteomyelitis generally depends on isolation of bacteria from a sterilely obtained bone biopsy sample with histologic evidence.…”

Section: Diagnosis Of Diabetic Foot Infectionsmentioning

confidence: 99%

Current Treatment of Diabetic Foot Infections and the Effect of Dermobor

Büke¹

2017

Cyprus J Med Sci

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One of the most serious chronic complications of diabetes is diabetic foot infections. Neuropathy, peripheral vascular disease and trauma are among the leading factors to development of diabetic foot ulcers and predispose to progress the diseases to diabetic foot infections. Delay of diagnosis and treatment and poor antibiotic treatment of diabetic foot infections can result in amputation. Diabetic foot ulcers and infections are the main causes of foot amputation around the world. The five-year survival rate of patients underwent foot amputation due to diabetic foot infections is low. With this review it's aimed to give information about the current epidemiology, risk factors, diagnosis and antimicrobial therapy of diabetic foot infections. In addition it's intended to give the results of Dermobor treatment in small number of cases with diabetic foot ulcers and infections.

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“…1 Swabs, for taking a culture are almost universally available in healthcare settings and are quick and easy to use. But, they may be susceptible to collecting contaminants and the inability to grow some pathogens.…”

Section: Introductionmentioning

confidence: 99%