Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb‐threatening diabetic foot infection

Pellizzer, Giampietro; Strazzabosco, Marco; Presi, S.; Furlan, Fernando Henrique; Lora, L.; Benedetti, Paolo; Bonato, M.; Erle, G; Lalla, Fausto de

doi:10.1046/j.1464-5491.2001.00584.x

Cited by 165 publications

(139 citation statements)

References 17 publications

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“…Some have found that tissue specimens are more sensitive and specific, containing fewer apparent contaminants and more pathogens than swab cultures [26,27]. Others have reported that with adequate preliminary debridement, the use of a wound swab is as reliable as the use of a tissue specimen [27,28].…”

Section: Discussionmentioning

confidence: 99%

Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose?

et al. 2010

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Aims/hypothesis We studied the bacterial aetiology and antibiotic sensitivity pattern of diabetic foot ulcers in India. Methods Records of 447 hospitalised patients between 1991 and 2008 were retrospectively analysed between two time periods (before and after 1999) to compare bacterial aetiology and antimicrobial sensitivity patterns. The first three consecutive cultures from the same wound during treatment were evaluated. Results Of 1,632 cultures, 66% were polymicrobial, 23% monomicrobial and 11% sterile. In the monomicrobial group, 14% (n=228) of cultures were Gram-negative, whereas 9% (n=147) were Gram-positive. The most common pathogens in the first culture were Pseudomonas aeruginosa (20.1%), Staphylococcus aureus (17.2%) and Escherichia coli (16.3%). Results for the third cultures showed persistence of P. aeruginosa (15.3%) and E. coli (14.2%). Gramnegative isolates dominated over Gram-positive ones (25.3% vs 15.1%, p<0.05). Antibiotic sensitivity patterns before and after 1999 were: piperacillin-tazobactam 74% vs 66% (p<0.005), imipenem 77% vs 85% (NS), cefoperazone-sulbactam 47% vs 44% (p<0.005), amikacin 62% vs 78% (NS), ceftriaxone 41% vs 36% (p<0.005), amoxicillinclavulanate 51% vs 43% (p<0.05) and clindamycin 43% vs 36% (p<0.005), respectively.

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Section: Discussionmentioning

confidence: 99%

Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose?

et al. 2010

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“…Our method used quantitative aerobic and anaerobic swab cultures as an alternative method when the HCP believed an invasive procedure would place the patient at risk. While this decision was based on the microbiological experimental [28,29], while others believe that superficial swab cultures of DFIs only complicate patient evaluation by sampling the superficial wound compartment, which may contain colonizing organisms rather than true pathogens. These divergent conclusions may be explained by different and non-standardized protocols.…”

Section: Discussionmentioning

confidence: 99%

Clinical and bacteriological survey of diabetic foot infections in Lisbon

Mendes

Marques-Costa

Vilela³

et al. 2012

Diabetes Research and Clinical Practice

127

101

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Infection Microbiology Portugal a b s t r a c tAims: An epidemiological survey of diabetic foot infections (DFIs) in Lisbon, stratifying the bacterial profile based on patient demographical data, diabetic foot characteristics (PEDIS classification), ulcer duration and antibiotic therapy.Methods: A transversal observational multicenter study, with clinical data collection using a structured questionnaire and microbiological products (aspirates, biopsies or swabs collected using the Levine method) of clinically infected foot ulcers of patients with diabetes mellitus (DM).Results: Forty-nine hospitalized and ambulatory patients were enrolled in this study, and 147 microbial isolates were cultured. Staphylococcus was the main genus identified, and methicillin-resistant Staphylococcus aureus (MRSA) was present in 24.5% of total cases. In the clinical samples collected from patients undergoing antibiotic therapy, 93% of the antibiotic regimens were considered inadequate based on the antibiotic susceptibility test results. The average duration of an ulcer with any isolated multi-drug resistant (MDR) organism was 29 days, and previous treatment with fluoroquinolones was statistically associated with multidrug resistance.Conclusions: Staphylococcus aureus was the most common cause of DFIs in our area. Prevalence and precocity of MDR organisms, namely MRSA, were high and were probably related to previous indiscriminate antibiotic use. Clinicians should avoid fluoroquinolones and more frequently consider the use of empirical anti-MRSA therapy.

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“…Attempt to obtain tissue samples, because these generally provide more accurate culture results than do superficial swab specimens (A-I). Most studies [41,42,84,85] indicate that the latter yield a greater range of organisms than do deeper-tissue material and yet may still fail to identify some of the deep flora. Standard swab specimens yield fewer anaerobes and are often minimally processed by the microbiology laboratory, but properly collected and transported anaerobic swab specimens may be adequate [86].…”

Section: Microbiologymentioning

confidence: 99%