Howell-Jones R S, Baker I B, McNulty C A M
Health Protection Agency Primary Care Unit, Gloucestershire Royal Hospital, Gloucester, UK.
J Wound Care. 2008 Aug;17(8):353-8. doi: 10.12968/jowc.2008.17.8.30799.
To investigate microbiology laboratory reporting policies, whether practitioners working in primary care adhered to the relevant guidelines when submitting swabs from venous leg ulcers (VLUs), and the impact of laboratory reports on antibiotic usage forVLUs.
Questionnaires were sent to all microbiology laboratories in England and Wales, and to clinicians who had submitted VLU swabs to one laboratory.
Ninety-five (47%) laboratories responded. Laboratories processed a mean of 7.3 leg ulcer swabs/100,000 population/week but were often unable to identify the leg ulcer aetiology from the clinical details provided. All laboratories stated that they routinely reported group A haemolytic streptococci and meticillin-sensitive and resistant Staphylococcus aureus; 75% always reported antibiotic susceptibility for these isolates. The majority reported other beta-haemolytic streptococci. A total of 126 clinicians (64%) returned their questionnaires; 100 had confirmed in their swab submission that the ulcer was of venous aetiology and so were included in the analysis. Eighty per cent of the swabs were submitted in accordance with guidelines, with increased pain (61%) being the most common reason. Discharge/exudate (52%) and malodour (41%) were common reasons for swab submissions, even though the guidelines do not cite them as clinical signs of infection. Reporting of antibiotic susceptibilities was associated with increased antibiotic usage.
Clinicians in primary care generally adhere to guidelines when submittingVLU specimens for microbiological investigation. Clinicians need to include clinical information with the swab so that laboratories can interpret the microbiology results. To reduce the use of antibiotics in the management ofVLUs, laboratories need to be selective in their organism and antibiotic-susceptibility reporting.
调查微生物实验室报告政策，基层医疗从业者在提交下肢静脉溃疡（VLU）拭子时是否遵循相关指南，以及实验室报告对VLU抗生素使用的影响。
向英格兰和威尔士的所有微生物实验室以及向一个实验室提交过VLU拭子的临床医生发送问卷。
95家（47%）实验室做出回应。实验室平均每周处理7.3份/10万人口的下肢溃疡拭子，但往往无法根据提供的临床细节确定下肢溃疡的病因。所有实验室均表示，他们常规报告A组溶血性链球菌以及对甲氧西林敏感和耐药的金黄色葡萄球菌；75%的实验室始终报告这些分离株的抗生素敏感性。大多数实验室报告其他β溶血性链球菌。共有126名临床医生（64%）回复了问卷；100人在提交拭子时确认溃疡为静脉病因，因此纳入分析。80%的拭子是按照指南提交的，疼痛加剧（61%）是最常见的原因。分泌物/渗出物（52%）和异味（41%）是提交拭子的常见原因，尽管指南并未将其列为感染的临床体征。抗生素敏感性报告与抗生素使用增加有关。
基层医疗临床医生在提交VLU标本进行微生物学调查时通常遵循指南。临床医生需要在拭子上附上临床信息，以便实验室能够解读微生物学结果。为减少VLU管理中抗生素的使用，实验室需要在报告病原体和抗生素敏感性时有所选择。
