Superficial Swab Research Articles

Etiological Agents of Superficial Surgical Site Infections among Post Operative Patients Attending a Teaching Hospital in Southeastern Nigeria

Surgical site infections (SSI) are infections at or around the site of incision where surgical procedure is conducted. It is a major cause of hospital morbidity, resulting in prolonged hospital stay, increased treatment costs, higher rates of re-operation, and even increased mortality rates. The etiological agents of superficial surgical site infections among post-operative patients attending a Teaching Hospital in Southeastern Nigeria were evaluated using standard microbiological methods. Seventy superficial surgical wound swab specimens were properly and aseptically obtained from post-operative patients after ethical clearance was duly obtained from the hospital’s ethical committee. Pure microbial cultures were obtained after 24 - 48 hours incubation, aerobically at 25oC, on blood, nutrient and Sabouraud’ Dextrose agar plates. The isolates were identified based on their morphological, physiological, biochemical and molecular characteristics. Out of the 70 surgical swab specimens collected, 81% were bacterial isolates which included Staphylococcus aureus 41%, Escherichia coli 16%, Pseudomonas aeruginosa 14% and Staphylococcus xylosus 10%. The fungi isolates (19%) were Candida tropicalis 8% and Trichosporon asahii 11%. These isolates were probably endogenous and exogenous flora from the patients’ and hospital’ environments respectively; thereby necessitating the need for adequate patient care before, during and after surgical procedures.

Reliability of superficial swab culture results compared with deep wound culture results in Fournier’s gangrene: a retrospective study

ObjectivesTo compare isolates from deep wound and superficial swab cultures to evaluate the detectability of pathogens by each culture in Fournier’s gangrene; and evaluate the association between microorganisms isolated from deep wounds and those isolated from blood or urine. MethodsPatients with Fournier’s gangrene who underwent debridement between October 2006 and January 2023 were retrospectively reviewed. In addition to comparing the isolates from deep wound cultures at initial debridement with those from superficial swab, blood, and urine cultures, the relationship between the traits of the organisms from deep wounds and patient disease severity and prognosis was examined. ResultsAmong 25 patients, deep wound and superficial swab cultures were obtained from 25 and 18 patients, respectively. The frequency of anaerobic isolates was significantly lower in the superficial cultures than in the deep wound cultures (31/76 versus 13/56, p = 0.034). Bacteria not isolated from deep wounds were isolated from superficial cultures in 55.6 % of the patients; the concordance rate between deep and superficial cultures was 27.8 % (5/18). The positive rates of blood and urine cultures were 20.8 % and 35.7 %, respectively; all isolates from the urine and blood cultures reflected the results of the deep wound culture. No significant association was observed between the severity or mortality and the type of causative bacteria. ConclusionsSuperficial swab cultures cannot be substituted for deep wound cultures in Fournier’s gangrene. Although the positivity rates for blood and urine cultures were not high, they were helpful in determining antibiotic de-escalation.

Evaluating Two Sampling Methods for Mycoplasma Bovis Diagnosis in American Bison (Bison bison).

Mycoplasma bovis is a bacterial pathogen endemic to cattle. In the early 2000s, M. bovis emerged as a cause of respiratory disease in American bison (Bison bison), causing significant morbidity and mortality. Bison herds that experience an outbreak of M. bovis are at higher risk for subsequent outbreaks, suggesting that chronic, subclinical infections can be established. Antemortem testing is therefore crucial to disease management; however, the precise sampling method to maximize detection of M. bovis in bison is unknown. We evaluated two sample types-superficial nasal swabs and deep nasopharyngeal swabs-collected from apparently healthy or symptomatic bison from January 2021 through December 2022. We used real-time PCR to detect M. bovis in 76/938 bison (8.1%) from 11 herds. For bison testing positive on at least one swab type, M. bovis was detected in 63/76 (82.8%) deep nasopharyngeal swabs and 29/73 (38.1%) superficial nasal swabs. Agreement between swabs for positive bison was 21% (n=16, kappa coefficient 0.319). We conclude that deep nasopharyngeal swabbing is more sensitive than superficial nasal swabbing for detection of M. bovis in bison and that low agreement between methods may be related to stage of infection. We further tested pooled samples by PCR and found that pooling of up to five samples can be effective to increase throughput and minimize costs. Management of wild bison relies on the ability to relocate animals to maintain gene flow and healthy populations. Sensitive and specific diagnostic tests are needed to inform decisions and minimize risk of transmission, especially from subclinical carriers. This study provides valuable insight that will inform best practices for M. bovis testing, thereby supporting the conservation of bison as healthy wildlife, which in turn promotes ecological restoration, safeguards cultural practices of Tribal Nations, and upholds the bison as a unique American icon.

Staphylococcus aureus Is the Predominant Pathogen in Hospitalised Patients with Diabetes-Related Foot Infections: An Australian Perspective.

Diabetes prevalence continues to increase worldwide, which has led to a rising incidence of diabetes-related foot infections (DFIs). There is significant local variation in the microbiology of DFIs, and Pseudomonas spp. is suggested to be more prevalent in subtropical climates. The aim of this study was to investigate the local microbiological findings in patients admitted to the hospital with DFIs. This retrospective study analysed data from all adult patients diagnosed with diabetes and admitted to the hospital for the treatment of a DFI between 1 January 2021 and 31 December 2022. Both superficial wound swabs and tissue cultures were included. The Infectious Diseases Society of America classification system was used to categorise the severity of the DFI. Patient characteristics and demographics were analysed using descriptive statistics. One hundred fifty-one episodes of care were included. Most of the DFIs were classified as moderate infections 101/151 (67%). The most commonly isolated microorganism was Staphylococcus aureus (33%) followed by normal skin flora (11%) and β-haemolytic streptococci (7%). P. aeruginosa was isolated more commonly in those with chronic DFIs (10%) compared to those with acute DFIs (2%). Despite the frequent identification of S. aureus, 83% of patients received an antipseudomonal antibiotic. The introduction of multidisciplinary DFI rounds should be considered.

Clinical impact of fungal colonization of burn wounds in patients hospitalized in the intensive care unit: a retrospective cohort study

BackgroundInvasive fungal infections in burn victims significantly increase mortality and hospitalization. The effect of fungal burn wound colonization has not been established.MethodsAll adult patients hospitalized in the intensive care unit...

Q-Scoring System for the Evaluation of the Superficial Wound Swab Samples: A Clinical Microbiological Aspect.

Wound swab cultures are frequently requested from patients suspected of having a wound infection. The quality of the sample should also be evaluated by performing a Gram-stained microscopic examination. "Q-scoring system" is not widely used and the literature on the subject is limited. A total of 4648 wound swab samples were evaluated. Samples with a Q-score of "0" were considered as "poor quality samples", and those with a score of " ≥ 1" were classified as "good quality samples". Microorganisms grown in the culture of samples that scored above one were identified by mass spectrometry, and antimicrobial susceptibility testing was performed. Gram stain results were found to be consistent with the culture result in 57.10% (n = 1078) of and inconsistent with the culture result in 42.90% (n = 813) of the samples. The number of samples with Q-scores one, two, and three among the 813 samples was 62, 29, and 722, respectively. The value observed in Q3 was found to be statistically significantly higher than the values observed in Q1 and Q2 (p < 0.05). Samples sent from surgical departments (61.92%) with a Q-score of ≥ 1, were statistically significant compared to internal medicine departments (p < 0.0001). There was no significant difference between samples sent from intensive care units and those sent from other inpatient services. For both groups with Q-scores ≥ 1 and "0" similar microorganisms were identified. As a conclusion, the Q-scoring system will provide a common language between the laboratory and the clinic, especially by standardizing the evaluation of wound swab samples.

Performance of fine-needle aspirate testing compared with superficial swab testing for quantification of BPV-1/−2 viral load in equine sarcoids

Bovine papillomavirus (BPV) types 1 and 2 are causally associated with equine sarcoid, the most common mesenchymal neoplasm of horses, but the viral load (VL) differs between lesions. Sensitive and accurate BPV detection and quantification is essential for clinicians to confirm clinical suspicion, as well as in research settings for stratifying these skin lesions. Due to the limitations of histopathology in sarcoid diagnosis, PCR screening of superficial swabs constitutes the principal sampling method for BPV detection. This study aimed to investigate the ability of superficial swabs and fine-needle aspirates (FNA) to accurately detect the VL in equine sarcoids, considering the main clinical types: occult, nodular, verrucous and fibroblastic. Superficial swabs and FNAs from a series of sarcoid-affected horses were tested in parallel for BPV DNA quantification. Quantitative real-time PCR screening of postoperative tissue biopsies served as reference standard for the accuracy assessment of the viral titters. Our results indicate that VL is not a predictor of the clinical type. Student's t-test results gave evidence of a significant difference between both sample methods (P < 0.001) with FNA giving the best approximation of the actual VL (P < 0.01). In contrast to superficial swabs, the reference standard correlated moderately with FNA in general (P < 0.05; r = 0.39) and strongly with FNA results within the occult sarcoid group (P < 0.05; r = 0.59). In conclusion, the correlation of FNA with the reference standard was strong enough to suggest this is the preferred method for quantifying VL in sarcoids.

Wound swab quality grading is dependent on Gram smear screening approach

Superficial skin swab collections are inherently low-quality and may be of little clinical value due to their poor sensitivity and specificity. Clinical microbiology laboratories can use Gram smears to screen and differentiate higher and lower quality specimens to direct the extent of potential pathogen work up, including antimicrobial susceptibility testing (AST). We compared the impact of two different smear grading approaches to our current reporting practices for superficial wound swab cultures. Two variations of the Q score methodology (low power under 10X (QS10) and high power under 100X (QS100) were compared to our existing oil immersion method (OM100) (100X). We further evaluated the QS100 method by scoring superficial swab smears previously screened by OM100 from cultures submitted between November 2018 and December 2019. No significant difference in the number of low-quality specimens (N = 50) was identified by QS10 or QS100 grading (N = 9; 18%; N = 8; 16% respectively). Among 968 additional QS100 screened smears, 67 (6.9%) low quality swabs were identified and 7.4% fewer organisms (76/1020 organisms) would require reporting with AST. Implementing the Q score for superficial wound swab cultures would provide minimal improvements in their clinical relevance, laboratory quality and efficiency in our laboratory due to the low number of poor-quality swabs received.

Comparison of Microbiological Results of Superficial Swab versus Deep Tissue Biopsy in Diabetic Foot Infections: A Prospective Observational Study from North India

Introduction: Diabetes mellitus is the leading cause of nontraumatic lower extremity amputation worldwide. Risk of developing a foot ulcer in diabetic patients has increased to 12-25% during their lifetime. Inappropriate sampling technique leading to contaminated samples is a well-known threat among patients of diabetic foot. In this study we compared two microbiological sampling techniques, superficial swabbing and deep tissue biopsy for identification of pathogens. Material and Methods: It was a prospective observational cross-sectional study. Diabetic foot was defined as per standard guidelines. Careful and meticulous examination of diabetic foot ulcer was done. Two specimens were collected from each wound. The first specimen was a wound swab collected by using Levine technique; another was taken via punch biopsy from the ulcer base. It was a deep tissue sample of 4 mm size. Results: A total of 120 diabetic patients with diabetic foot infection were included in this study. In swab culture 80.83% patients had mono microbial growth, 15% had polymicrobial and 4.10% had no growth. In deep tissue culture 87.50% had mono microbial growth, 2.50% had poly microbial and 10% were sterile. Staphylococcus aureus was most common isolate followed by E. coli. It was observed that though monomicrobial growth was most common in both the types of samples but was higher in deep tissue biopsy than in superficial swab samples. Conclusion: The isolation of microorganism via deep tissue sampling in diabetic foot ulcer patients is more reliable compared to superficial swab samples and a better guide to antibiotic therapy.

Cross-sectional comparison of superficial swab and fine-needle aspiration: Improving the diagnostic workup of horses with sarcoids

Although bovine papillomavirus (BPV)-induced equine sarcoids are often identified solely by clinical examination, confirmation of the clinical diagnosis is essential for correct treatment selection. Only few approaches are presently available for this purpose. PCR-based screening for BPV in superficial swabs is widely-used to support clinical suspicion. While this method effectively detects sarcoid involvement in ulcerated lesions, sensitivity is lower in tumors with intact epithelium. This cross-sectional study compared the diagnostic characteristics of superficial swabs and fine-needle aspirates (FNA) with the aim to validate FNA as an alternative sampling method to detect BPV in suspect lesions. Among 63 lesions confirmed as sarcoids from 58 horses, compared to swabs FNA detected a greater proportion of BPV positives in general (swab, 70 %,;95 % confidence intervals [CI], 58.5 %−81.2 %; FNA, 98 %, 95 % CI, 95.3 %−100 %; P = 0.0001) and among a non-ulcerated subgroup (swab, 63 %, 95 % CI, 50.4 %−76.6 %; FNA, 98 %, 95 % CI, 91.4 %−100 %; P = 0.0001). Furthermore, the sensitivity, as well as the negative predictive value and accuracy of FNA for matched samples from 58 horses were superior to surface swabbing for the group of all horses and the subgroup that included only lesions with an intact epidermis (n = 48), with differences ranging from 23 % (95 % CI, 11.4 %−34.6 %) to 52 % (95 % CI, 25.9 %−78.1 %). Other advantages of FNA identified were a higher chance of adequate sampling and a reduced risk of unwanted detection of superficial contamination or latent BPV in keratinocytes. The ability to consistently detect BPV in all clinical lesion types indicates that FNA shows promise as a valid diagnostic tool to improve the consistency and quality of the diagnostic workup of equine sarcoids.

The spectrum, management and outcome of cellulitis in subtropical South Africa.

This study aimed to ascertain the microbiology, severity stratification, and clinical outcomes of cellulitis based on our current management for comparison with international reports. A retrospective chart review was conducted of all patients with cellulitis treated by the department of surgery at Ngwelezana Hospital over an 18-month period. Severity of cellulitis was graded, and a comparison was made of the Eron and Modified Dundee classifications. Superficial swabs were taken for culture on patients who had cellulitis with open wounds or blisters. Culture results, antibiotics used, need for surgical intervention, and length of hospital stay were documented and analysed. One hundred and thirty-four patients had cellulitis. Severity grading for classes I-IV in the Eron classification was 3%, 57%, 39% and 1%, respectively, and for the Modified Dundee classification, 47%, 11%, 38%, and 4%, respectively. Co-amoxiclav was the most used antibiotic (73%). Superficial skin swabs were taken from 49 patients and 34 cultured 44 specific organisms. The most common organism identified was Staphylococcus aureus (30%). Several gram-negative and anaerobic organisms were cultured. Fifty-three patients required surgical debridement of the infected area and one patient required an above-knee amputation. Mean hospital stay for patients who did not receive surgical intervention was 6 days (IQR 3) and 7 days (IQR 4) for those who did. There were no deaths. The Dundee classification triages fewer patients as class 2 severity than the Eron system and its use has the potentail to reduce the number of patients hospitalised. Gram-positive organisms predominated in those cultured, but gram-negative cultures were frequent compared to other reported series. Co-amoxiclav is effective as first-line antimicrobial therapy in our environment.

Value of Next Generation Microbial DNA Sequencing in Sexually Related Infections in Heterosexual Dyads

ABSTRACT Introduction Sexually related infections, including cystitis and vaginitides in the female, and cystitis, urethritis and prostatitis in the male, as well as infections of the external genitalia in both genders were previously thought to be uncommonly transmitted from member to member of a dyad. Newer microbial detection techniques have allowed for more rapid identification of potential pathogens. However, persistence of an infection in a partner remains a perplexing diagnostic and therapeutic dilemma, raising the question of transmission of an infectious organism from a potentially asymptomatic partner. Objective To evaluate the benefit of mutual, synchronous microbial detection assays in dyads in whom at least one partner has a persistent, symptomatic infection that could be transmitted by sexual activity. Methods Twenty-six (26) heterosexual, monogamous couples underwent synchronous microbial testing including traditional laboratory culture techniques and polymerase chain reaction (PCR) and next generation sequencing (NGS) with a urine specimen, superficial and deep vaginal swab specimens in the female and urine and semen specimens in the male. Both genders had swab specimens of the external genitalia. The female member was symptomatic in 17 of the couples, the male in 4, and both were symptomatic in 5 couples. Results from all assays were tabulated and comorbid pathogens were treated with concurrent appropriate antimicrobials, using guidelines for therapeutic choices and duration of antimicrobial course. Sexual abstinence was required for the duration of the antimicrobial therapy. To assess efficacy, repeat assays were done after a time frame sufficient to allow for relapse/recurrence of the infection. Results Traditional culture techniques failed to demonstrate the significant pathogen(s) in at least one member of the dyad in all but 3 couples. This failure emerged from two primary foci: one methodological, in which automated techniques discarded specimens with low microbial growth or multiple organisms. The other was failure to identify the organism entirely. PCR identified the pathogen in at least one member in 11 of the 26 dyads, but NGS detected pathogens in both members in all the couples. Novel pathogens were detected, organisms previously thought to be commensal or contaminants. Multiple pathogen detection was common, occurring in 17 couples. Conclusions A frequent concern of patients and clinicians for those patients who have persistent, potentially sexually related infections is the underlying contribution from a partner. Limitations in accurate microbial detection often complicate eradication of the infection. Only NGS found significant pathogens on synchronous assays of all dyads tested, allowing organism specific concurrent antimicrobial therapy of both members. These results suggest a new algorithm for detection and therapy in patients whose persistent infection may involve the contribution of a partner. Disclosure No

Polymicrobial and Multiple Blood Stream Infection Episodes as Risk Factors for On-Pump Mortality in Mechanical Circulatory Support Patients

<h3>Purpose</h3> Despite our improving experience with the expanding use of mechanical circulatory support systems for end-stage heart failure, device related infection remains prevalent. This study aims to better characterize the clinical impact of blood stream infections (BSIs) over a 26-year period. <h3>Methods</h3> This was a single center retrospective study of patients with durable mechanical circulatory supports implanted from June 1994 to December 2020 as bridge-to-transplantation. Patients were studied for the incidence of BSIs, number of on-pump support days, transition to transplant and on-pump mortality. Descriptive statistics and relationships between the incidences or types of infections and on-pump mortality were analyzed. <h3>Results</h3> Two-hundred and fifty patients (204 males, 82%) with average age at implant of 52.1±13.7 years and average INTERMACS score of 1.9±0.7 were studied. Implanted devices included 221 (88.4%) left VADs, 17 (6.8%) biVADs and 8 (3.2%) total artificial hearts. Average on-pump duration was 377±381 days. There were 108 (43%) patients with one or more BSIs, and 0.42 events per patient year. Of these cases, 71 (28.4% of total patients, 65.7% of all BSI episodes) were single episodes, whilst 37 had multiple episodes (occurring at least seven days after index infection) and 28 had polymicrobial growths (2 organisms or more during time on-pump). The major responsible organisms for initial BSI were staphylococci (67.6%), streptococci (8.3%) and enterococci (6.5%) species. There were 93 (37.2%) patients with positive microbiology growths from superficial driveline site swabs, of which 46 out of 93 (49.5%) had BSIs. On logistic regression against hypertension, diabetes mellitus and requirement for dialysis, positive driveline microbiology was a significant predictor of mortality (p=0.01). Amongst patients with BSIs, there were significantly increased proportions of on-pump mortality for those who had multiple BSIs (p=0.03) or BSIs with multiple organisms (p<0.01). <h3>Conclusion</h3> Infections, either sequential or with multiple organisms, are significant markers for on-pump mortality. Whilst limiting any infection is important at the outset of device implantation, this study highlights the importance and urgency of timely recognition and early administration of targeted and intensive antimicrobial therapies.

Routine bacterial culture of proximal bone specimens during minor amputation in patients with diabetes-related foot infections has little clinical utility in predicting re-operation or ulcer healing

BackgroundTrans-phalangeal and trans-metatarsal amputation, collectively termed ‘minor amputations’ are important procedures for managing infections of diabetes-related foot ulcers (DFU). Following minor amputation, international guidelines recommend a prolonged course of antibiotics if residual infected bone on intra-operative bone samples are identified, but the quality of the evidence underpinning these guidelines is low. In this study, we examined the concordance of microbiological results from proximal bone cultures compared to results from superficial wound swabs in relation to patient outcomes; with the aim of determining the utility of routinely obtaining marginal bone specimens.MethodsData was retrospectively collected on 144 individuals who underwent minor amputations for infected DFU at a large Australian tertiary hospital. Concordance was identified for patients with both superficial wound swabs and intra-operative bone samples available. Patient outcomes were monitored up to 6 months post-amputation. The primary outcome was complete healing at 6 months; and secondary outcome measures included further surgery and death. Mann Whitney U testing was performed for bivariate analyses of continuous variables, Chi-Squared testing used for categorical variables and a logistic regression was performed with healing as the dependent variable.ResultsA moderate-high degree of concordance was observed between microbiological samples, with 38/111 (35%) of patients having discordant wound swab and bone sample microbiology. Discordant results were not associated with adverse outcomes (67.2% with concordant results achieved complete healing compared with 68.6% patients with discordant results; P = 0.89). Revascularisation during admission (0.37 [0.13–0.96], P = 0.04) and amputation of the 5th ray (0.45 [0.21–0.94], P = 0.03) were independent risk factors for non-healing.ConclusionThere was a moderate-high degree of concordance between superficial wound swab results and intra-operative bone sample microbiology in this patient cohort. Discordance was not associated with adverse outcomes. These results suggest there is little clinical utility in routinely collecting proximal bone as an adjunct to routine wound swabs for culture during minor amputation for an infected DFU.

Comparison of bacteriologic culture results for skin wound swabs and skin wound biopsy specimens.

To compare bacteriologic culture results for superficial swab and tissue biopsy specimens obtained from dogs with open skin wounds. 52 client-owned dogs. For each dog, 1 wound underwent routine preparation prior to collection of 2 specimens, 1 by superficial swab (Levine) technique and 1 by tissue biopsy. Specimens were processed for bacteriologic culture. Two observers determined whether any detected difference in culture results for the 2 types of specimen would have resulted in differing treatment plans. Culture results of swab and tissue biopsy specimens were identical in 11/52 (21.2%) cases. Tissue biopsy specimen and swab cultures yielded positive results for 44 (84.6%) and 40 (76.9%) wounds, respectively. With regard to mean recovery rates of bacteria from wounds with positive culture results, both the biopsy specimens and swabs yielded 3.4 bacterial species/wound. All wounds for which swab cultures yielded no growth also had negative culture results for biopsy specimens. Biopsy specimen and swab culture results were in agreement with regard to the most common bacteria cultured. In 7/52 (13%) wounds, the observers would have treated the patient differently on the basis of the results of the 2 cultures. Results indicated that culture of a swab collected by the Levine technique is an appropriate noninvasive alternative to culture of a tissue biopsy specimen. A negative result obtained from culture of a swab is likely to be reliable. Disagreement between the results of swab and tissue biopsy specimen cultures is likely of low clinical importance.

Genomic analysis of group A Streptococcus isolated during a correctional facility outbreak of MRSA in 2004

In 2004-2005, an outbreak of impetigo occurred at a correctional facility during a sentinel outbreak of methicillin- resistant Staphylococcus aureus (MRSA) in Alberta, Canada. Next-generation sequencing (NGS) was used to characterize the group A Streptococcus (GAS) isolates and evaluate whether genomic biomarkers could distinguish between those recovered alone and those co-isolated with S. aureus. Superficial wound swabs collected from all adults with impetigo during this outbreak were cultured using standard methods. NGS was used to characterize and compare all of the GAS and S. aureus genomes. Fifty-three adults were culture positive for GAS, with a subset of specimens also positive for MRSA (n = 5) or methicillin-sensitive S. aureus (n = 3). Seventeen additional MRSA isolates from this facility from the same time frame (no GAS co-isolates) were also included. All 78 bacterial genomes were analyzed for the presence of known virulence factors, plasmids, and antimicrobial resistance (AMR) genes. Among the GAS isolates were 12 emm types, the most common being 41.2 (n = 27; 51%). GAS genomes were phylogenetically compared with local and public datasets of invasive and non-invasive isolates. GAS genomes had diverse profiles for virulence factors, plasmids, and AMR genes. Pangenome analysis did not identify horizontally transferred genes in the co-infection versus single infections. GAS recovered from invasive and non-invasive sources were not genetically distinguishable. Virulence factors, plasmids, and AMR profiles grouped by emm type, and no genetic changes were identified that predict co-infection or horizontal gene transfer between GAS and S. aureus.

Superficial Tissue Swabs Versus Deep Tissue Samples in the Detection of Microbiological Profile of Infected Diabetic Foot Ulcerations.

This study aimed to determine the most accurate microbiological test for the detection of micro-organisms in infected diabetic foot ulcerations in people living with type-2 Diabetes. For 20 eligible patients, a superficial tissue swab and a deep tissue sample were taken during a regular appointment at a Diabetes out-patient's Podiatry Clinic. Two specimens were collected from each wound for microbial culturing after debridement. Infected foot ulcerations were graded according to the Wagner's classification as per clinical protocol. This study found a significant difference [p = 0.028] between the two different samples. The deep tissue sample was found to be more accurate in identifying micro-organisms than the superficial swabs, although the latter is more widely used in clinical practice. Further studies are warranted to provide more evidence to clinicians on the best method to adopt when swabbing different types of diabetic foot ulcerations with different wound classification since, it is clearly still a matter of debate how to detect wound infection.

Culturomics Approach to Identify Diabetic Foot Infection Bacteria.

The main goal of the study was to evaluate the usefulness of the culturomics approach in the reflection of diabetic foot infections (DFIs) microbial compositions in Poland. Superficial swab samples of 16 diabetic foot infection patients (Provincial Polyclinical Hospital in Toruń, Poland) were subjected to culturing using 10 different types of media followed by the identification via the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and Biotyper platform. Identified 204 bacterial isolates representing 18 different species—mostly Enterococcus faecalis (63%) and Staphylococcus aureus (44%). Most of the infections (81%) demonstrated a polymicrobial character. Great differences in the species coverage, the number of isolated Gram-positive and Gram-negative bacteria, and the efficiency of the microbial composition reflection between the investigated media were revealed. The use of commonly recommended blood agar allowed to reveal only 53% of the entire microbial composition of the diabetic foot infection samples, which considerably improved when the chromagar orientation and vancomycin-resistant enterococi agar were applied. In general, efficiency increased in the following order: selective < universal < enriched < differential media. Performed analysis also revealed the impact of the culture media composition on the molecular profiles of some bacterial species, such as Corynebacterium striatum, Proteus mirabilis or Morganella morganii that contributed to the differences in the identification quality. Our results indicated that the culturomics approach can significantly improve the accuracy of the reflection of the diabetic foot infections microbial compositions as long as an appropriate media set is selected. The chromagar orientation and vancomycin-resistant enterococi agar media which were used for the first time to study diabetic foot infection microbial profiles demonstrate the highest utility in the culturomics approach and should be included in further studies directed to find a faster and more reliable diabetic foot infection diagnostic tool.

Investigating bacterial decolonization for the prevention of radiation dermatitis: A randomized controlled trial and quality of life assessment.

TPS12137 Background: Radiation dermatitis (RD) can be therapy-limiting and detrimental to quality of life for cancer patients receiving radiation therapy (RT). Bacteria play an important role in many inflammatory dermatoses. In an observational clinical study, our group discovered that nasal colonization with bacteria, specifically with Staphylococcus aureus (SA), prior to RT was an independent predictor of higher-grade RD (grade ≥2). Higher-grade RD patients were also found to have more SA on the irradiated skin after treatment. If successful, bacterial decolonization could be a safe and cost-effective method to prevent RD. Methods: This is a randomized controlled trial assessing the efficacy of universal bacterial decolonization in preventing RD. Subject inclusion criteria include patients who are aged ≥ 18 years with a diagnosis of a solid tumor of the breast or head and neck with plans for fractionated RT (≥ 15 fractions) with curative intent. Based on previous studies and power analyses, we plan to recruit a total of 80 patients. Patients in the control arm will be treated according to standard of care, including daily application of emollients and gentle bathing. In addition to standard of care, patients in the intervention arm will receive a decolonization regimen consisting of intranasal mupirocin ointment used twice daily and chlorhexidine wash used daily for 5 days prior to the initiation of RT and repeated for 5 days every other week throughout RT. Study evaluations for both groups will include bacterial cultures obtained via superficial swab from the nares, irradiated skin, and contralateral non-radiated skin performed at the beginning, middle, and end of RT. Additionally, standardized photographs of the skin at the radiated site will be performed prior to and at the completion of RT, which will be graded by a dermatologist blinded to study arm. Lastly, at identical timepoints, each patient will complete the SKINDEX-16 questionnaire, a validated quality of life (QoL) assessment. The primary endpoint is development of grade ≥ 2 RD, as compared to low-grade RD (grade 0-1), during RT. The secondary endpoint includes the impact of bacterial decolonization on QoL. Pearson’s chi square or Fisher’s exact tests will be used to compare the incidence rates of higher-grade RD between the interventional arm and control arm to assess if the intervention is associated with a lower incidence rate of higher-grade RD. Paired t-tests will be used to compare the QoL score change from baseline to after RT between the two arms. Linear regression models will be used in both analyses to adjust for covariates. Clinical trial information: NCT03883828.

Microorganisms that Reproduce in Wound Cultures in Rize Region and Their Antimicrobial Susceptibility

Objective: Among nosocomial infections, wound infections are one of the important factors causing mortality and morbidity after urinary tract infections. In this study, it was aimed to guide the empirical treatment and to contribute to epidemiological data by determining the microorganism and antimicrobial susceptibility which have been isolated from cultures of wounds and abscesses, which came from outpatient clinics, services and intensive care units, that grow in wound site and abscess cultures that comes from outpatient clinics, services and intensive care units.Methods: This study was conducted on the basis of cultures in which at least one microorganism grew in the wound site and abscess samples from the polyclinic, service and intensive care units during routine application at the Recep Tayyip Erdoğan University Training and Research Hospital Microbiology Laboratory, between January 2011 and December 2016. Samples were taken with two sterile swabs in the form of superficial swabs or deep aspiration and delivered to the laboratory with transport medium as soon as possible. Gram staining preparation was prepared and inoculated on 5% sheep blood agar, eosin-methylene-blue agar, chocolate agar and sabouraud dextrose agar. The gram-stained preparation was evaluated by Q scoring. Evaluation of the culture and antibiogram susceptibility were made according to the Clinical and Laboratory Standards Institute (CLSI) criteria.Results: A total of 2202 samples were received, and reproduction was observed in 930 samples. Among the 793 wound and 137 abscess samples, the most common microorganism was Staphylococcus aureus (224 cultures) and the second was Escherichia coli (135 cultures).Conclusion: Surgery clinics, especially orthopedics, provided the most common wound infections, from which S. aureus was the most isolated microorganism. The fact that bacterial, most notably S. aureus, propagation occurred from surgery samples indicates that surgical site infections are generally caused by endogenous flora. It has, thus, become apparent in our study that patients and hospital staff should pay more attention to hygiene, especially hand washing. Due to the changing of the distribution and resistance patterns of microorganisms that are frequently seen in hospitals at certain time intervals, their antibiotic susceptibility will be a guide in the rational use of antibiotics. Thus, specific treatment will contribute to the saving on the cost and reduce mortality.