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  4. Pressure Ulcers in Patients with Spinal Cord Injuries: Concordance Between Swab and Intraoperative Culture

Pressure Ulcers in Patients with Spinal Cord Injuries: Concordance Between Swab and Intraoperative Culture

Plast Reconstr Surg Glob Open, 2016 · DOI: 10.1097/GOX.0000000000000640 · Published: March 18, 2016

Spinal Cord InjuryHealthcareDermatology

Simple Explanation

In patients with spinal cord injuries, pressure ulcers are often complicated by infection. Treating these infections surgically requires the right antibiotics, but choosing those antibiotics is difficult because many types of bacteria can be involved. This study compares the results of wound swab cultures with cultures taken directly from tissue during surgery to see how well the swabs predict the actual infection-causing bacteria. The goal is to determine if swab cultures are a reliable way to choose the correct antibiotics for treating infected pressure ulcers in spinal cord injury patients.

Study Duration
July 2011 to January 2014
Participants
64 adult patients with SCI
Evidence Level
Prospective, observational, single-centre study

Key Findings

  • 1
    The results of swab cultures matched the intraoperative cultures in only 25% of the cases.
  • 2
    In 40% of cases, the swab cultures identified different microorganisms than the intraoperative cultures, indicating a lack of reliability.
  • 3
    The presence of osteomyelitis (bone infection) was associated with a higher rate of disagreement between swab and intraoperative culture results.

Research Summary

This study evaluated the accuracy of using swab cultures to identify the bacteria causing infection in pressure ulcers of spinal cord injury (SCI) patients. The study found that swab cultures only matched the results of cultures taken during surgery in 25% of cases, suggesting they are not very reliable. The authors conclude that swab cultures are not reliable enough to guide antibiotic choices, especially when osteomyelitis is present.

Practical Implications

Antibiotic Selection

Relying solely on swab cultures to select antibiotics for pressure ulcer infections in SCI patients may lead to inappropriate treatment.

Diagnostic Approach

More invasive diagnostic methods, such as tissue biopsies, may be necessary for accurate identification of infecting organisms, particularly when osteomyelitis is suspected.

Clinical Practice

Clinicians should interpret swab culture results with caution and consider other factors, such as clinical presentation and the possibility of osteomyelitis, when choosing antibiotics.

Study Limitations

  • 1
    Single-center study
  • 2
    Limited sample size of 64 patients
  • 3
    Focus on patients undergoing surgical debridement

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