Infectious Disease Unit, Sant'Orsola-Malpighi Teaching Hospital - Alma Mater Studiorum University of Bologna, Bologna, Italy.
Montecatone Rehabilitation Institute, Imola, Italy.
Clin Microbiol Infect. 2017 Dec;23(12):943-947. doi: 10.1016/j.cmi.2017.04.015. Epub 2017 Apr 19.
To assess the predictive value of superficial ulcer swab culture to make a microbiological diagnosis of deep wound infections in spinal cord injury (SCI) patients with advanced-stage pressure ulcers.
From July 2011 to February 2014, we performed a prospective, single-centre study on adult SCI patients undergoing scheduled surgical debridement and reconstruction for advanced-stage pressure ulcers, at Montecatone Rehabilitation Institute, a 150-bed hospital dedicated to SCI care. Three superficial ulcer swabs were preoperatively collected using the Levine technique, then sent for culture. In surgery, multiple bone and soft-tissue specimens were taken and sent for culture and histological examination. No antibiotics were administered before surgery. The results of swabs and intraoperative specimens were compared.
In all, 116 patients were included, median age 49 years; a majority were males with post-traumatic paraplegia. According to intraoperative specimen cultures, the most common micro-organisms were Staphylococcus aureus, Proteus mirabilis, and Pseudomonas aeruginosa, found in 31, 27, and 16 cases, respectively. Concordance between superficial swabs and intraoperative specimen culture was found in only in 25 out of 116 cases (22%). The main reason for non-concordance was the yielding of different micro-organisms (41 out of 116); false negatives (swab negative/intraoperative positive) accounted for 31 out of 116 and false positives (swab positive/intraoperative negative) for 19 out of 116. When compared with intraoperative specimens, sensitivity and specificity of the swab culture were 80% and 54%, respectively.
Our results confirm that in patients with advanced-stage pressure ulcers, the cultures of a superficial ulcer swab are not useful in either the diagnosis of a superinfection or the prediction of the role of involved micro-organisms.
评估浅层溃疡拭子培养对脊髓损伤（SCI）并发晚期压疮患者深部伤口感染进行微生物学诊断的预测价值。
2011 年 7 月至 2014 年 2 月，我们在一家 150 张床位的 SCI 康复治疗中心（Montecatone 康复研究所），对计划接受手术清创和重建的晚期压疮 SCI 成人患者进行了一项前瞻性单中心研究。术前采用 Levine 技术采集 3 份浅层溃疡拭子，然后进行培养。术中采集多处骨和软组织标本进行培养和组织学检查。术前未使用抗生素。比较拭子和术中标本的结果。
共纳入 116 例患者，中位年龄 49 岁；大多数为创伤后截瘫的男性。根据术中标本培养，最常见的微生物分别为金黄色葡萄球菌、奇异变形杆菌和铜绿假单胞菌，分别为 31、27 和 16 例。116 例中仅 25 例（22%）浅层拭子与术中标本培养结果一致。不一致的主要原因是培养出不同的微生物（116 例中有 41 例）；假阴性（拭子阴性/术中阳性）占 116 例中的 31 例，假阳性（拭子阳性/术中阴性）占 116 例中的 19 例。与术中标本相比，拭子培养的敏感性和特异性分别为 80%和 54%。
我们的研究结果证实，对于晚期压疮患者，浅层溃疡拭子培养对预测深部伤口感染或感染微生物的作用并无帮助。
