Internal Medicine/Geriatrics, University of Wisconsin, Madison, Medical College of Wisconsin, Milwaukee, Waupaca, WI 54981, USA.
J Am Med Dir Assoc. 2012 Jan;13(1):75-9. doi: 10.1016/j.jamda.2011.04.012. Epub 2011 May 31.
Prescribing systemic antibiotics without susceptibility testing has significant shortcomings, especially in long term care facilities with high rates of multidrug-resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus. Tissue biopsy or aspiration sampling of infected tissue is the "gold standard" for culture of skin and soft tissue infection and is especially important with serious infection, systemic toxicity, or failure of initial therapy. Swab cultures are probably the most commonly used method to determine the resistance pattern of skin pathogens treated in nursing home residents. However, they are controversial, especially when obtained from chronic wounds. The culture may be obtained from an uninfected wound and lead to unnecessary antibiotic therapy. If material superficial to the infected living tissue is sampled, colonizers may be isolated. This report is focused on swab culture obtained by the Levine technique, after debridement or cleaning down to viable tissue when an acute purulent skin infection has been diagnosed based on clinical criteria. Swab cultures should not be used to determine IF a wound is acutely infected; rather the role may be to identify potential pathogens when deep tissue biopsy is not elected. The swab culture may identify the pathogen or overlying MDRO colonization, a risk factor for MDRO infection. MDRO isolation should heighten the clinician's level of concern if the prescribed antibiotic did not "cover" the MDRO or potential pathogen that was isolated. Properly performed swab cultures could play a role in the identification of methicillin-resistant Staphylococcus/MDRO infections treated in nursing homes.
在没有药敏试验的情况下开具全身用抗生素具有显著的缺点，尤其是在长期护理机构中，这些机构存在高比率的耐多药生物体（MDROs），包括耐甲氧西林金黄色葡萄球菌。感染组织的组织活检或抽吸取样是皮肤和软组织感染培养的“金标准”，对于严重感染、全身毒性或初始治疗失败的情况尤其重要。拭子培养可能是确定养老院居民治疗的皮肤病原体耐药模式最常用的方法。然而，它们存在争议，特别是在慢性伤口中获得时。该培养物可能来自未感染的伤口，并导致不必要的抗生素治疗。如果仅采集到感染性活组织表面的材料，则可能会分离出定植菌。本报告重点介绍了在基于临床标准诊断出急性脓性皮肤感染后，通过清创术或清洁至有活力的组织，用 Levine 技术获得的拭子培养物。当未选择深部组织活检时，拭子培养物的作用可能是识别潜在的病原体，而不是用于确定伤口是否急性感染。拭子培养物可能会鉴定病原体或覆盖 MDRO 定植，这是 MDRO 感染的一个危险因素。如果所开的抗生素没有“覆盖”分离出的 MDRO 或潜在病原体，那么 MDRO 的分离应引起临床医生的高度关注。正确进行的拭子培养可能在识别养老院治疗的耐甲氧西林金黄色葡萄球菌/MDRO 感染方面发挥作用。
