Sample procurement for cultures of infected wounds: a systematic review

Copeland-Halperin, Libby R.; Kaminsky, Alexander J.; Bluefeld, N; Miraliakbari, Reza

doi:10.12968/jowc.2016.25.sup4.s4

Cited by 54 publications

(65 citation statements)

References 55 publications

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“…The search located 8134 articles and 80 articles were included for final full‐text review (Figure ). There was one systematic review—level I evidence which compared the value in identifying pathogens between wound swab and wound biopsy techniques. Six expert opinion or consensus documents, which focused on diagnosis of infection in chronic wounds and/or CLUs were also included .…”

Section: Resultsmentioning

confidence: 99%

“…The authors found that for chronic wounds, including VLUs, both types of techniques were comparable for initial wound monitoring; however, swabs were better when performing quantitative analysis. The swabs were also found to be most valuable for identifying pathogens in infected diabetic foot ulcers that did not involve bone . Gardner et al in a study of 83 patients with chronic wounds (5 VLUs) defined “true” wound infections if the bacterial load from quantitative cultures was ≥10 6 organisms per gram of viable wound tissue and compared three techniques to obtain samples, which included wound biopsy, wound swab with the Z technique, and wound swab with the Levine's technique.…”

Section: Resultsmentioning

confidence: 99%

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The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice

Bui

Finlayson

Edwards

2019

International Wound Journal

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This literature review aimed to provide a narrative review of evidence on validity of clinical and microbial indicators of infection and to gain insights into the diagnosis of infection in chronic leg ulcers (CLUs). A search was conducted in Cinahl, Medline, the Cochrane Library databases, Embase, Web of Science, ScienceDirect, Pubmed, PsycINFO, ProQuest dissertations, and Google Scholar from January 1990 to July 2017. The inclusion criteria were original studies, systematic reviews, and consensus documents focused on “infection” in CLUs, English language, clinical and community settings, and human. The reviewed studies were inconsistent in criteria for infection between investigated wound types and lack of specificity regarding wound types. There were few studies investigating the criteria for diagnosis of infection in leg ulcers. The identification of leg ulcer infection still remains problematic and relies on out‐of‐date and not uniform evidence. Literature in this area was mostly limited to level III and IV evidence based on The Australian National Health and Medical Research Council Levels of Evidence, or expert opinion. This literature review showed seven clinical signs and symptoms that could be diagnostic for infection in CLUs, including: new, increased, or altered ulcer pain; malodour; increased ulcer area; wound breakdown, delayed or non‐healing; and erythema and increased local temperature, whilst the microbial indicators used to diagnose infected leg ulcers were varied and regarded as less important.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice

Bui

Finlayson

Edwards

2019

International Wound Journal

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“…A wound swab for microbiological analysis was taken according to the Levine procedure; a sterile cotton swab (Copan ESwab, COPAN Diagnostics, Murrieta, CA) was twirled for 5 seconds on a one square centimeter area of the wound bed, while applying light pressure. This Levine swabbing method is believed to be the most accurate, since it allows collection of bacteria from deeper tissue in the wound with the swab . Subsequently, the wound was anaesthetized by directly applying lidocaine drops (lidocaine HCL 20 mg/mL) onto the wound bed if anesthesia was deemed necessary by either the patient or the physician, nurse practitioner, or wound care nurse.…”

Section: Methodsmentioning

confidence: 99%

“…Studies that aimed to include a broad range of chronic wounds either had a small sample size or excluded patients types that are frequently seen in wound care centers (e.g., patients with arterial wounds, diabetes mellitus, or anticoagulation therapy) limiting the generalizability to clinical practice. In addition, the applicability in clinical practice is often complicated by the absence of a clear description of the sampling method (biopsy, swab) and calculation of outcome measures …”

Section: Introductionmentioning

confidence: 99%

Wound swab and wound biopsy yield similar culture results

Haalboom

Blokhuis-Arkes

Beuk

et al. 2018

Wound Repair Regeneration

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The question remains whether wound swabs yield similar culture results to the traditional gold standard, biopsies. Swabs are not invasive and easy to perform. However, they are believed to capture microorganisms from the surface rather than microorganisms that have invaded tissue. Several studies compared swabs and biopsies using different populations and sampling methods, complicating the ability to draw conclusions for clinical practice. This study aimed to compare swab and biopsy in clinical practice, by including a variety of wounds and using standard sampling and culture procedures. Swabs (Levine technique) and biopsies were taken for microbiological culture in a standardized manner from the same location of one wound for each patient. Statistical analyses were performed to determine overall agreement, and observed agreement and kappa for specific microorganisms. A variety of wounds of 180 patients from different healthcare facilities in The Netherlands were included. Skin flora was more frequently cultured from swabs, resulting in similar recovery rates when excluding skin flora (1.34 vs 1.35). Swabs were able to identify all microorganisms cultured from biopsies in 131 wounds (72.8%) wounds. Most frequently identified organisms were Staphylococcus aureus, Pseudomonas aeruginosa, and beta-haemolytic streptococci species. Observed agreement and kappa for these organisms varied between 87.2 and 97.8% and 0.73 and 0.85, respectively. This study demonstrates that swabs and biopsies tend to yield the same culture results when taken from the same location. For frequently occurring microorganisms, agreement between the two methods was even higher. Therefore, there seems to be no direct need for invasive biopsy in clinical practice.

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“…However, tissue biopsy is rarely used for culture and sensitivity testing in either veterinary * or human medicine 5 . This limited use has been attributed in human medicine to invasiveness of biopsy techniques, pain, and cost 10,12‐14 . By contrast, wound swabbing is minimally invasive, easier to perform, less likely to generate pain, and therefore widely used in human and veterinary clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of the influence of sampling method on bacterial culture results and antimicrobial selection in 52 dogs with infected wounds

Concannon

Kidd

Osmond

et al. 2020

J Vet Emergen Crit Care

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Objective To determine the influence of sampling methods on culture results and selection of antimicrobials for treating infected wounds in dogs. Design Prospective study from January to July 2016. Setting Three private multispecialty referral centers. Animals Fifty‐two client‐owned dogs with infected wounds. Interventions Each wound was sampled for culture by 3 methods: swabbing prior to preparation (dirty swabs), swabbing after debridement and sterile lavage (clean swabs), and biopsy. Bacterial species and phenotypes were compared. Three clinicians unaware of patient, wound, and sampling information selected antimicrobial drugs based on culture and sensitivity reports. Antimicrobials were divided into class I, II, or III based on established guidelines. The number, highest class of antimicrobial chosen, and inter‐investigator agreement were examined. Measurements and Main Results Identical populations of bacteria were isolated for all 3 sampling techniques in only 31% of wounds. Significantly fewer bacterial species were isolated from biopsy samples (1.87 bacterial species per wound ± 1.14) than from clean swab samples (2.29 ± 1.18; P = 0.009) but not dirty swab samples (2.29 ± 1.29; P = 0.06). The recovery frequency for gram‐positive bacteria was lower for biopsy compared to either swabbing technique (P = 0.001 for both comparisons). No difference was observed between clean and dirty swabbing techniques for any parameter examined. Sampling technique did not affect the proportion of wounds with anaerobic, gram‐negative, or multi‐drug resistant bacteria. The number (P = 0.28) and highest class of antimicrobial (P = 0.9) selected per wound did not differ between the 3 sampling techniques (P = 0.28). Clinician agreement was 83–90% depending on sampling technique. Conclusion Although there were some differences in bacteria isolated from biopsy samples compared to swab samples from infected wounds, technique did not influence the number and highest class of antimicrobial selected by clinicians. Wound debridement prior to sampling by swabbing did not alter the number or type of bacteria isolated, nor the number or the highest class of antimicrobial selected by clinicians.

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Sample procurement for cultures of infected wounds: a systematic review

Cited by 54 publications

References 55 publications

The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice

The diagnosis of infection in chronic leg ulcers: A narrative review on clinical practice

Wound swab and wound biopsy yield similar culture results

Prospective evaluation of the influence of sampling method on bacterial culture results and antimicrobial selection in 52 dogs with infected wounds

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