Pellizzer G, Strazzabosco M, Presi S, Furlan F, Lora L, Benedetti P, Bonato M, Erle G, de Lalla F
Department of Infectious Diseases, San Bortolo Hospital, Vicenza, Italy.
Diabet Med. 2001 Oct;18(10):822-7. doi: 10.1046/j.1464-5491.2001.00584.x.
The results of ulcer swabbing vs. deep tissue biopsy have been compared prospectively in 29 diabetic patients with limb-threatening foot infection, to investigate the effectiveness and reliability of each method, and to evaluate whether any of the two could be more suitable for the microbiological follow-up of severe lesions.
Microbiological samples were collected by using both methods at fixed intervals after therapy commencement (i.e. at day 0, 7, 14, and 30). Statistical comparison was performed between the results of each sampling procedure after the end of follow-up.
At enrolment, the mean number of isolates per patient was 2.34 by swabbing and 2.07 by tissue biopsy sampling; the rate of isolation for anaerobes with the two methods was 35% and 25%, respectively; no statistical differences could be observed between the two procedures in terms of either species or frequency of isolation. Anaerobic species were never detected after the first 2 weeks of appropriate treatment, and those ulcers which were still active at day 30 yielded almost exclusively Gram-positive bacteria. At the end of follow-up, deep tissue cultures appeared to exhibit a higher diagnostic sensitivity with respect to swabs.
Swabbing and deep tissue cultures appear to be equally reliable for the initial monitoring of antimicrobial treatment in severe diabetic foot infection. However, our experience seems to suggest that deep tissue might be more sensitive than swabbing for monitoring those isolates that have been selected for antibiotic resistance, i.e. those from ulcers that are still active after 30 days of treatment.
对29例患有威胁肢体的足部感染的糖尿病患者进行前瞻性比较溃疡拭子采样与深部组织活检的结果，以研究每种方法的有效性和可靠性，并评估两者中是否有更适合严重病变微生物学随访的方法。
在治疗开始后的固定时间间隔（即第0、7、14和30天）使用两种方法采集微生物样本。随访结束后，对每个采样程序的结果进行统计学比较。
入组时，通过拭子采样每位患者分离菌的平均数量为2.34，通过组织活检采样为2.07；两种方法厌氧菌的分离率分别为35%和25%；在分离菌的种类或频率方面，两种程序之间未观察到统计学差异。在适当治疗的前2周后从未检测到厌氧菌，在第30天仍有活性的溃疡几乎仅培养出革兰氏阳性菌。随访结束时，深部组织培养相对于拭子似乎显示出更高的诊断敏感性。
拭子采样和深部组织培养对于严重糖尿病足感染抗菌治疗的初始监测似乎同样可靠。然而，我们的经验似乎表明，对于监测那些已产生抗生素耐药性的分离菌，即治疗30天后仍有活性的溃疡中的分离菌，深部组织可能比拭子更敏感。
