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OBJECTIVES: To 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. METHODS: Patients 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. RESULTS: Among 25 patients, deep wound and superficial swab cultures were obtained from 25 to 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. CONCLUSIONS: Superficial 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.

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INTRODUCTION: Necrotizing otitis externa (NOE) is a serious, progressive, and potentially life-threatening infection of the external auditory canal, affecting soft tissue and bone. The most common organism causing NOE is Pseudomonas Aeruginosa and less common are Fungal infections. When managing a patient with NOE, a culture is taken from the EAC in order to tailor the appropriate antimicrobial treatment, however commonly, the culture is sterile. Inflammation biomarkers may be used as adjuncts to inform on the differential diagnosis and as prognostic markers. AIM: To characterize and compare values and ratios of components of the complete blood count (CBC) at admission, at patients with positive swab culture. METHODS: A retrospective study of NOE patients was conducted. We included all patients admitted between the years 2001-2023, for whom a culture swab tested positive. We compared CBC findings at hospitalization between bacteria and fungi-positive culture patients. RESULTS: Eosinophils-to-Neutrophils Ratio (ENR) was significantly lower in the fungal group compared to the bacterial group 0.023 ± 0.02 and 0.04 ± 0.03, respectively (p-value = 0.025). Eosinophils-to-Leukocyte Ratio (ELR) was significantly lower in the fungal group compared to the bacterial group 0.058 ± 0.04 and 0.12 ± 0.1 respectively (p-value = 0.009). For definition of ELR ≤ 0.1 we found that, sensitivity was 88% (95%CI = 0.679-0.979) and NPV 90% (95%CI = 0.709-0.982). For definition of ENR ≤ 0.03 sensitivity was 88% (95%CI = 0.679-0.979) and NPV 88% (95%CI = 0.679-0.979). CONCLUSION: Lower values of ELR and ENR in patients with NOE are associated with fungal infection and can serve as a tool in adjusting an appropriate antimicrobial therapy in cases of sterile or when no culture is available.

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Antiinfecciosos , Infecciones Bacterianas , Otitis Externa , Humanos , Eosinófilos , Neutrófilos , Otitis Externa/diagnóstico , Otitis Externa/microbiología , Estudios Retrospectivos , Linfocitos , Biomarcadores

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Introduction: One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis. Methods: A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis. Results: Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever. Conclusions: Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.

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OBJECTIVE: To assess the predictive value of swab cultures of cryopreserved skull flaps during cranioplasties for surgical site infections (SSIs). METHODS: A retrospective review was conducted of consecutive patients who underwent delayed cranioplasties with cryopreserved autografts between 2009 and 2017. The results of cultures obtained from swabs and infected surgical sites were assessed. The accuracy, sensitivity, and specificity of swab cultures for SSIs were evaluated. RESULTS: The study included 422 patients categorized into two groups, swab and nonswab, depending on whether swab cultures were implemented during cranioplasties. The overall infection rate was 7.58%. No difference was seen in infection rates between groups. There were 18 false-positive and no true-positive swab culture results. All bacteria between swab cultures and SSI cultures were discordant. Meanwhile, there were 19 false-negative swab cultures. The results showed high specificity but low sensitivity for swab cultures to predict SSI occurrence and the pathogens. CONCLUSIONS: Owing to low accuracy and sensitivity, swab cultures of cryopreserved autografts should not be routinely performed during delayed cranioplasties.

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Carga Bacteriana/métodos , Craneotomía/efectos adversos , Criopreservación/métodos , Manejo de Especímenes/métodos , Colgajos Quirúrgicos/microbiología , Infección de la Herida Quirúrgica/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carga Bacteriana/tendencias , Niño , Preescolar , Craneotomía/tendencias , Criopreservación/tendencias , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Manejo de Especímenes/tendencias , Colgajos Quirúrgicos/trasplante , Infección de la Herida Quirúrgica/etiología , Técnicas de Cultivo de Tejidos/métodos , Técnicas de Cultivo de Tejidos/tendencias , Adulto Joven

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INTRODUCTION: The role of perioperative cultures to identify infection in open fractures has been doubtful. The method of sampling for cultures in open fractures includes swab or tissue collection. However, the efficacy of either of these two techniques has not been compared in the setting of an acute open fracture. We conducted a study to compare the bacteriological culture results between the two techniques. METHODOLOGY: A pilot study was done at our institution, where all type 2, 3A, and 3B open fractures admitted in the emergency and operated for debridement and stabilization were included in the study. Intraoperatively, after debridement of the wound, swab and tissue specimens were collected and sent to the same laboratory. The results of the cultures were then collected for comparison after the necessary incubation period. Follow-up of outpatient records was also done to see its clinical significance. RESULTS: A total of 30 samples of swab and tissue cultures collected post-debridement of acute open fractures in the operation theater were studied. Only 13 samples grew an organism either in swab/tissue culture or both. Nine tissue samples and eight swab samples showed growth. In four cases, both swab and tissue showed growth, but the same organism grew in only one instance. The other three cases showing growth in both tissue and swab had different organisms. Statistically, the kappa coefficient was found to be 0.26 and the agreement between swab and tissue culture was found fair. However, the kappa did not account for the species of the organisms. Tissue samples showed more number of specific organism growing in them, compared to swab culture samples. CONCLUSION: The ideal technique of taking samples for culture in acute open fractures is uncertain. Tissue culture may be better in isolating specific organisms in an acute open fracture wound. However, it is uncertain if the same organism may cause infection.

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Perianal infectious dermatitis (PID) represents a superficial inflammation of the perianal skin, which is of bacterial origin (classically, group A beta-hemolytic streptococci). This narrative review aims to critically review and summarize the available scientific literature regarding pediatric PID, being the first of its kind, to the best of the author's knowledge. It also reports the first cases of Romanian children with PID. Multiple databases were subjected to systematic literature search (from 1966 to April 30, 2018) to identify studies and case reports of children with PID. As such, this review provides updated information about essential aspects of PID (epidemiology, etiology, pathogenesis, as well as clinical features, required investigations and therapeutic options) and of diagnostic pitfalls. Although a well-defined entity, PID remains largely underdiagnosed. PID may mimic other common conditions with skin manifestations (like candidiasis, pinworms, eczema, irritant dermatitis, anal fissure, hemorrhoids, Crohn's disease, psoriasis, seborrheic dermatitis, zinc deficiency dermatosis and even sexual abuse), with consequent unnecessary, sometimes expensive and invasive investigations and futile therapies, which cause patients and families discomfort and distress. Since PID has an unremitting course, early recognition is imperative, as it allows for prompt and efficacious antibiotic therapy. However, PID represents a stubborn condition and, even if properly treated, its recurrence rate remains high. Further well-designed prospective randomized controlled trials, with adequate follow-up, are required in order to formulate the optimum personalized antibiotic therapy (oral alone or in association with topical medication), able to prevent recurrences. Awareness of this condition by healthcare professionals should improve patient outcomes.

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Background@#Term prelabor rupture of membranes (PROM) increases the risk of maternal and neonatal infections. @*Objective@#To compare rates of positive bacterial growth in placental swab cultures done among women who received ampicillin prophylaxis at different timings after term PROM. @*Design@#Matched cohort study. @*Setting@#Department of Obstetrics and Gynecology at Southern Philippines Medical Center in Davao City, Philippines. @*Participants@#120 pregnant women aged ≥18 years old, at ≥37 weeks age of gestation, with PROM: 40 women received ampicillin within 6 hours (6H group), 40 within >6 to 12 hours (12H group), and 40 within >12 to 18 hours (18H group) of onset of PROM. @*Main outcome measures@#Rates of positive bacterial growth in postpartum placental swab cultures; most common bacterial isolates; and signs of intraamniotic infection (IAI).

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Ampicilina , Manejo de Especímenes

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OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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Úlcera por Presión/microbiología , Traumatismos de la Médula Espinal/complicaciones , Infección de Heridas/microbiología , Adulto , Anciano , Biopsia , Desbridamiento , Femenino , Humanos , Masculino , Persona de Mediana Edad , Úlcera por Presión/etiología , Úlcera por Presión/cirugía , Estudios Prospectivos , Infecciones por Proteus/diagnóstico , Infecciones por Proteus/microbiología , Proteus mirabilis , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/microbiología , Sensibilidad y Especificidad , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Infección de Heridas/diagnóstico

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Health-care professionals are increasingly relying on wound cultures as part of their clinical assessment. Tissue viability nurses in the UK use wound swabbing as the standard specimen-taking technique, but others are used globally and there is no worldwide standard. This study compares two wound culture techniques in uninfected chronic wounds of active and former injection drug users seeking care through a civic needle exchange mobile wound clinic. For each wound, two sampling approaches were applied during the same visit: swab culture and curetted tissue culture. A total of 12 chronic wounds were assessed among 9 patients, including 19 swab cultures and 19 tissue cultures. These 38 cultures grew a total of 157 individually identified bacterial organisms, including 27 anaerobic organisms (17.2%), 63 Gram-positive species (40.1%), and 67 Gram-negative species (42.7%). The swab technique yielded a greater percentage recovery rate of anaerobic (55.6%), Gram-positive (52.4%), and all species (51.6%) compared to tissue culture (P>0.05). Recovery of common wound species, such as methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa was the same using either method (50.0%). Swab and curetted tissue cultures yielded similar recovery rates for common wound bacteria. Therefore, swabs (including a vacuum transport container) may offer an advantage in the recovery of anaerobes. Based upon this analysis, the swabbased culture method for chronic wounds currently used in the UK is reasonable.

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Técnicas de Cultivo , Infección de Heridas/microbiología , Infección de Heridas/enfermería , Baltimore , Enfermedad Crónica , Humanos , Programas de Intercambio de Agujas , Abuso de Sustancias por Vía Intravenosa/complicaciones , Cicatrización de Heridas

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Serum Antistreptolysin O (ASO) titre is raised when there is infection of any organ of the body, by Group A beta haemolytic streptococci (GABHS), Group C or Group G streptococci [1]. Increased serum ASO titre should not be the only deciding criterion for tonsillectomy if GABHS is not present in the palatine tonsils. In this study, we evaluate the rationality of performing tonsillectomy in raised serum ASO titre only, in absence of GABHS in palatine tonsil. The study was designed as a prospective cohort study in which the main out come measure is to find out: The main outcome measure is to find out whether only the raised serum ASO titre is to be considered to perform tonsillectomy or not. Fifty consecutive patients (both children and adults) clinically diagnosed to have chronic tonsillitis were included in this prospective cohort study. Throat swab culture, tonsilar core tissue culture and Serum ASO titre tests were performed in all the patients. The results showed that out of the 50 patients 45 had raised ASO titre and 5 patients had normal ASO titre. GABHS was found in 5 cases (10 %) in throat swab culture and 8 cases (16 %) in FNA of tonsil core culture. The sensitivity of throat swab culture as compared to FNA Tonsil core culture was 62.5 % and positive predictive value was 100 %. The sensitivity of ASO titre as compared to core culture was 100 % and positive predictive value was 17.8 %. Specificity was only 12 %. From the results of this study, it is evident that FNA culture of the tonsil core is a valid and a reliable test for the diagnosis of bacterial micro flora in recurrent tonsillitis. One should perform throat swab culture and FNA culture from tonsil core along with ASO titre before doing tonsillectomy in absence of any other indications. Identifying GABHS in the tonsil by FNA test and/or in the throat swab culture along with high serum ASO titre may be one of the ideal indications for tonsillectomy.

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OBJECTIVE: Infections are one of the most important and potentially serious complications of burn wounds. Quantitative biopsy cultures are useful for showing that a burn wound infection is not present, but these cultures are not useful for showing that an infection is present. Swab cultures are used to diagnosis surface colonization and may not accurately reflect the organism(s) causing the wound infection. MATERIALS AND METHODS: To perform a comparison of surface swab and biopsy cultures for isolated microorganisms from burn wounds, 160 biopsy/surface swab pairs were collected from 160 patients. RESULTS: Seventy-seven patients (48.1%) showed positive micro-organism cultures from the burn wounds; 19.3 percent had both positive surface cultures and significant bacterial counts from the biopsy cultures, whereas 28.8 percent of the patients had only positive surface cultures. There was moderate agreement (41%) between the results of surface swab and quantitative biopsy cultures used to diagnose burn wound infections. Pseudomonas aeruginosa (45.5%) was the most predominantly isolated bacteria from the wounds, and there was good concordance between the results of the surface swab and quantitative biopsy culture samples (78%). Coagulase-negative Staphylococci (CNS) and Escherichia coli strains were only isolated from the surface swab samples because they are colonizing bacteria. The univariate analysis revealed that there were significant associations between the results of the positive biopsy cultures and the total surface body area, open flame burns, prolonged hospitalization and female gender (p<0.05). CONCLUSION: Surface swab and quantitative biopsy cultures have a high rate of concordance in predicting P. aeruginosa invasion and the colonization of E. coli and CNS strains in burn wounds.

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AIM: To conduct a bacterial culture study for monitoring decontamination of automated endoscope reprocessors (AERs) after high-level disinfection (HLD). METHODS: From February 2006 to January 2011, authors conducted randomized consecutive sampling each month for 7 AERs. Authors collected a total of 420 swab cultures, including 300 cultures from 5 gastroscope AERs, and 120 cultures from 2 colonoscope AERs. Swab cultures were obtained from the residual water from the AERs after a full reprocessing cycle. Samples were cultured to test for aerobic bacteria, anaerobic bacteria, and mycobacterium tuberculosis. RESULTS: The positive culture rate of the AERs was 2.0% (6/300) for gastroscope AERs and 0.8% (1/120) for colonoscope AERs. All the positive cultures, including 6 from gastroscope and 1 from colonoscope AERs, showed monofloral colonization. Of the gastroscope AER samples, 50% (3/6) were colonized by aerobic bacterial and 50% (3/6) by fungal contaminations. CONCLUSION: A full reprocessing cycle of an AER with HLD is adequate for disinfection of the machine. Swab culture is a useful method for monitoring AER decontamination after each reprocessing cycle. Fungal contamination of AERs after reprocessing should also be kept in mind.

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Colonoscopios/microbiología , Desinfección/normas , Contaminación de Equipos/estadística & datos numéricos , Gastroscopios/microbiología , Recuento de Colonia Microbiana , Equipo Reutilizado , Humanos , Control de Infecciones

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PURPOSE: To know the true carrier rate and the immunologic responses (antistreptolysin O :ASO) to beta-hemolytic streptococci which obtained from normal school children with or without carrying streptococci. And to study the clinical meaning of the number of organisms found in culture. METHODS: One hundred ninty-eight first grade of elementary school children were included. I obtained throat swab culture from tonsil and tonsilar fossa with sterile cotton ball stick and plated on sheep blood agar dish, counted number of colonies of beta-hemolytic streptococci (BHS) after overnight incubation, examined ASO titer (Rantz-Randall method) simultaneously, and differentiated grouping of BHS with Streptex. RESULTS: 1) Of the 198 normal school children, 34 (17.2%) had cultured BHS. 16 (8.1%) were group A, 4 (2.0%) were group C, 2 (1.0%) were group G, and 12 (6.1%) were non-grouping BHS. 2) 14 (22.2%) out of 63 normal children without carrying BHS and 16 (47.1%) out of 34 with carrying BHS had come out above 250 units of ASO. 13 (59.1%) out of 22 group A,C,G streptococcal carriers had showed above 250 units of ASO. The true carrier rate of BHS were 18 (9.0%) out of 198 elementary school children. 3) When I had counted the number of colonies from 34 carrier of BHS, 1+ was 67.6% and 2+ was 17.6%. It was 85.2% of total children with carrier. 4) There were significant differences between the mean titer of logarithmic ASO obtained from group A BHS carrier and that of normal children without carrying BHS (P=0.001), and differences between that of group A and group B,C,G streptococci (P= 0.0005). CONCLUSIONS: The ASO titer obtained from BHS carrier is higher than normal school children, which suggests the possibility of subclinical infection, the possibility of persistent habor of organism since past infection had contracted, and the possibility of replaced old organism in past infection with new organism. It should be performed follow-up study for identifying the persistence of immunologic response in accordance with or without culturing organism.

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Niño , Humanos , Agar , Antiestreptolisina , Infecciones Asintomáticas , Tonsila Palatina , Faringe , Ovinos