Steer J A, Papini R P, Wilson A P, McGrouther D A, Parkhouse N
Department of Microbiology, University College London Hospitals, UK.
Burns. 1996 May;22(3):173-6. doi: 10.1016/0305-4179(95)00116-6.
The diagnosis and treatment of burn wound infection is commonly determined by clinical impression and the qualitative results of surface swabs. It has been suggested that quantitative bacteriology from burn wound biopsies confirms burn wound infection and improves patient management. Methods for quantitating surface flora have been described, but comparisons with biopsy specimens have been contradictory. The quantitative and qualitative results of 141 pairs of biopsies and surface swabs, from 74 burn patients, were compared. Staph. aureus was the commonest organism isolated (29 per cent of biopsies and 35 per cent of swabs). Recovery of the same set of species from biopsy and swab occurred in 54 per cent of pairs. There was a significant correlation between the bacterial count obtained by biopsy and by surface swab (P < 0.001), but using various threshold values, the predictive value of the counts obtained by one method to predict the counts obtained by the other was poor. Parallel cultures taken on 18 occasions, showed a significant correlation between bacterial counts obtained from two biopsies or two swabs taken simultaneously (P < 0.002), but there was wide variation in bacterial densities from the same burn wound at the same time. Recovery of the same set of species from both biopsies occurred in 56 per cent of pairs, and from both swabs in 50 per cent of pairs. The use of quantitative microbiology in burns is limited by the unreliability of a single surface swab or biopsy to represent the whole burn wound.
烧伤创面感染的诊断和治疗通常由临床判断以及创面拭子的定性结果来确定。有人提出，烧伤创面活检的定量细菌学可确诊烧伤创面感染并改善患者管理。已有描述定量表面菌群的方法，但与活检标本的比较结果相互矛盾。对74例烧伤患者的141对活检标本和表面拭子的定量和定性结果进行了比较。金黄色葡萄球菌是分离出的最常见病原体（活检标本中占29%，拭子中占35%）。54%的配对活检标本和拭子中分离出相同种类的细菌。活检和表面拭子获得的细菌计数之间存在显著相关性（P<0.001），但使用各种阈值时，一种方法获得的计数预测另一种方法获得的计数的预测价值较差。18次同时进行的平行培养显示，同时采集的两份活检标本或两份拭子获得的细菌计数之间存在显著相关性（P<0.002），但同一烧伤创面在同一时间的细菌密度差异很大。两份活检标本中均分离出相同种类细菌的配对占56%，两份拭子中均分离出相同种类细菌的配对占50%。烧伤中定量微生物学的应用受到单个表面拭子或活检标本不能可靠代表整个烧伤创面的限制。
