Comparison of Surface Swab Cultures and Quantitative Tissue Biopsy Cultures to Predict Sepsis in Burn Patients: A Prospective Study

Abstract

This study aimed at evaluating the possibility of predicting septicemia in burn patients by using wound surface and tissue culture techniques as well as blood cultures. Fifty patients with full-thickness burn wounds covering at least 10% of the total body surface area were included. Signs of septicemia were noted in 21 patients (42%) and 29 patients died (58%). The bacterial colonization of the burn wounds consisted mainly of Staphylococcus aureus and Pseudomonas aeruginosa. Sepsis was better correlated to quantitative burn tissue biopsy cultures than surface swab cultures but the time needed for processing limits its predictive and therapeutic value.

Burn Wound Infections

“…Conflicting results have been obtained by different studies for the following reasons: burn patients do not have homogenous injuries (e.g., the severity and extent of burn injury vary greatly from patient to patient), various sampling techniques and laboratory methods have been used, and most comparative studies were done before the advent of early excision therapy (41,48,247,254,255,282,399,407,408,423). Steer and colleagues (407,408) have reported the largest recent studies that compared the results of surface swab versus biopsy cultures.…”

“…Herruzo-Cabrera and colleagues (205) showed that a semiquantitative surface swab method distinguished between wound contamination and infection, using 10 5 organisms/g as a threshold for the definition of infection by biopsy. Sjoberg and colleagues (399) recently reported that quantitative tissue biopsies gave a better prediction of sepsis than surface swabs but concluded that the amount of labor involved in collection and analysis of multiple biopsy samples limited the clinical relevance of this approach. Bharadwaj and colleagues (41) also assessed the value of blood cultures in the diagnosis of burn wound sepsis compared to burn wound cultures by either swab or tissue biopsy.…”

“…Clinical microbiology laboratories routinely provide semiquantitative or qualitative results from cultures of superficial wound samples. A number of techniques for the collection of burn wound surface cultures have been described over the last several decades, including the collection of swabs or contact plates and capillarity gauze sampling (48,160,247,399,407,408,423,459). Although each of these methods is described for historical completeness, modern burn units universally rely on the collection of surface swabs.…”

The role of quantitative bacteriology on burn wound management

“…But a coordinated approach using quantitative tissue biopsy, blood, and urine samples can provide a best approach in assessing the burn patients with sepsis. 24,25 So the main aim for any strategy dealing with burn wounds should have definite goals in achieving an effective infection control .The goals should be to prevent transmission of exogenous organisms to patients or personnel, to control the transmission of endogenous organism, that is, the normal flora to sites at increased risk of infection and to protect and support existing defense's in patients with seriously impaired resistance.…”

Comparison of Surface Swab and Quantitative Biopsy Cultures Dependent on Isolated Microorganisms from Burn Wounds

“…Steer et al [14,15] showed that the concordance between the two methods was 54%. Sjöberg et al [19] indicated that the results of the surface cultures and tissue cultures were identical in 29% of cases; that is, the samples either showed no growth or identical bacterial growth.…”