comparison of microbiology cultures from deep tissue biopsies … · 2018. 3. 30. · comparison of...
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Comparison of microbiology
cultures from deep tissue
biopsies compared to
superficial swabs from
infected diabetic ulcers
Steven Brookes-Fazakerley
David Harvey
Simon Platt
Gillian Jackson
Wirral University Hospital NHS Foundation Trust
UK
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Comparison of microbiology cultures
from deep tissue biopsies compared to
superficial swabs from infected diabetic
ulcers
My disclosure is in the
Final AOFAS Mobile App.
I have no potential conflicts with
this presentation.
Steven Brookes-Fazakerley
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Aim
• To evaluate whether deep tissue biopsy cultures are more accurate & valuable than superficial swab cultures in determining the pathological organisms present in diabetic ulcers
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Methods
• Prospective study
• 23 consecutive patients over 9 month period
• All diagnosed & treated in 1 UK hospital
• All patients suffered diabetes mellitus
• All patients suffered an intractable ulcer of the lower limb
• All patients had wound deep tissue biopsy with & superficial wound swab culture
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Demographics
• 23 ulcers in 23 patients
• Mean age 58 years (39-86 years)
• 57% involved left lower limb
• 65% (15) male patients
• 65% (15) type 2 diabetics & 35% (8) type 1
• 84% (21) insulin dependent patients
• Median BMI 29.5kg/m2
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Ulcer Location
Hallux 22%
1st MT Head 4%
Lesser Toes 31%
Lesser MT Heads 22%
Os calcis 13%
Forefoot & hindfoot
4%
BKA Stump 4%
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Organism Superficial Swabs
Cultures Deep Soft Tissue
Culture Bone Culture
Anaerobes 3 9 8
Coagulase negative staphylococci 0 5 3
Diptheroids 1 4 0
S. aureus (not MRSA) 5 9 8
E.coli 1 1 0
Enterococci 5 3 3
Enterobacter 0 1 0
β haemolytic Group B Streptococci 2 2 1
β haemolytic Group C Streptococci 1 1 1
Haemophilus parainfluenzae 0 1 1
Klebsiella spp 0 4 1
Mixed Skin & enteric flora 12 0 0
Morganella morganii 0 2 1
MRSA 1 1 0
Proteus spp 1 3 3
Pseudomonas spp 2 2 2
Serratia spp 1 0 0
Stenotrophomonas maltaphilia 0 1 1
Streptococcus anginosus 0 1 1
Streptococcus mitis 0 1 1
Isolates Grown From Swabs &
Tissue Cultures
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Pathogenic Isolates Missed by Swabs
& Cultured Per Tissue Specimen
Patient number Organism
1 S.aureus
2 H.parainfluenzae
4 Klebsiella spp
5 Anaerobes, Enterobacter & S.aureus
7 Proteus spp
10 Anaerobes
11 Anaerobes & S.aureus, S. anginosus
14 S.aureus
15 Klebsiella spp
16 Anaerobes
17 Anaerobes & S.aureus
18 Klebsiella spp
21 Proteus spp
23 Anaerobes & M. morganii
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Culture Results
• 74% (17) superficial swabs grew extra organisms (i.e.
bone pathogen & other probable superficial colonisers)
• 13% (3) superficial swabs cultured less organisms than
bone samples (i.e. undercalled the extent of infection)
• 13% (3) superficial swabs cultured different organisms to
bone samples (i.e. incorrect/misleading)
• 52% (12) deep soft tissue & bone cultures were identical
Mean Number Isolates from Swab & Tissue Cultures
Swab Cultures Deep Soft Tissue Bone
1.7 (1-4) 2.3 (1-4) 1.86 (0-4)
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Discussion
• Superficial swabs largely isolated enteric
organisms & mixed skin flora
• Superficial swabs failed to identify potential
pathogenic organisms seen in 61% of patients
deep tissue samples
• Bone cultures isolated fewer organisms than
deep soft tissue cultures
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Conclusion
• Poor concordance between isolates of
superficial swabs & deep tissue specimens
• Deep tissue specimens from diabetic ulcers
capture more pathogenic organisms
• Superficial swabs are inferior to deep tissue
samples & should not be used to guide antibiotic
treatment
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References
1. Mackowiak PA, Jones SR, Smith JW. Diagnostic value of sinus-tract cultures in
chronic osteomyelitis. J Am Med Assoc 1978; 239: 2772- 2775.
2. Sharp CS, Bessman AN, Wagner FW Jr, Garland D. Microbiology of deep tissue in
diabetic gangrene. Diabetes Care 1978; 1:289- 292.
3. Sharp GS, Bessman AN, Wagner FW Jr, Garland D, Reece E. Microbiology of
superficial and deep tissues in infected diabetic gangrene. Surg Gynecol Obstet
1979; 149: 217-219.
4. Sapico FL, Canawati HN, Witte JL, Montogomerie JZ, Wagner FW Jr, Bessman AN.
Quantitative aerobic and anaerobic bacteriology of infected diabetic feet. J Clin
Microbiol 1980; 12: 413-420.
5. Sapico FL, WitteJL, Canawati HN, Montgomerie JZ, Bessman AN. The infected foot
of the diabetic patient: quantitative microbiology and analysis of clinical features. Rev
Infect Dis 1984; 6: 5171 -5176.
6. Lipsky BA, Pecoraro RE, Larson SA, Hanley ME, Ahroni JH. Outpatient management
of uncomplicated lower-extremity infections in diabetic patients. Arch Intern Med
1990; 150: 790-797.
7. Slater R.A, Lazarovitch T, Boldur I. Swab cultures accurately identify bacterial
pathogens in diabetic foot wounds not involving bone. Diabet Med 2004; 21: 705-709.