title: Assessment of bacterial infection in chronic wounds in the elderly: biopsy versus VERSAJET.
abstract: OBJECTIVE
  The aim of this study was to evaluate the hydro-surgery VERSAJET system as a suitable alternative to the traditional invasive tissue sampling technique in detecting bacteria and their load in chronic wounds in the elderly.
  
  
  METHODS
  To investigate and evaluate bacterial incidence and load in chronic wounds, we simultaneously performed on 19 affected patients a deep tissue biopsy and tissue collections by the VERSAJET hydro-surgical system. After local cleaning and anesthesia, a deep biopsy was performed with a punch of 3-4 mm in diameter. Subsequently, three tissue samples were collected by the VERSAJET system: one from the first washing in order to investigate the superficial contamination; one from the second washing to investigate deep tissue infection investigation and one from the third washing as a control procedure. After treatment, all tissue samples were cultured in vitro for diagnostic and micro-biological assessment.
  
  
  RESULTS
  Nineteen patients with chronic wounds of the lower limbs were enrolled from February 2010 to May 2013. Concordance between deep tissue biopsy cultures and tissue cultures collected by the VERSAJET system was examined. The deep tissue biopsy cultures showed complete concordance with the VERSAJET as follows: 2 patients (11%) for the first washing sample; 10 patients (53%) for the second washing sample; 4 patients (21%) for the third washing sample. However, with reference to only aerobic isolated strains, the concordance of the VERSAJET second washing samples cultures with a biopsy of the deep tissue cultures was very high (84%) and fairly high (63%) in the anaerobic isolated strains. The second VERSAJET washing sample cultures seem to have the highest concordance with the biopsy of the deep tissue cultures.
  
  
  CONCLUSIONS
  Tissue biopsy remains the leading technique for detecting bacteria and their load in chronic wounds. However, this study shows that the hydro-surgery VERSAJET system is sufficiently effective in detecting bacteria and their load in chronic wounds and can be a potential alternative to a biopsy. In particular, the second washing sample culture showed the best correlation with the deep tissue biopsy culture. However, further studies are needed in order to modify techniques of tissue collection in the VERSAJET system before drawing any conclusions.
authors.affiliation: Department of Clinical and Experimental Internal Medicine "F. Magrassi and A. Lanzara", Second University of Naples, Italy. Electronic address: edi.mattera@unina2.it.
authors.forename: Edi
authors.initials: E
authors.lastname: Mattera
authors.affiliation: Department of Experimental Medicine, Second University of Naples, Italy. Electronic address: mariarosaria.iovene@unina2.it.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Iovene
authors.affiliation: Department of General Surgery - ASL NA1, Cardinale Ascalesi Hospital, Naples, Italy. Electronic address: super_rbros@hotmail.com.
authors.forename: Corrado
authors.initials: C
authors.lastname: Rispoli
authors.affiliation: Breast Unit, A.O. IRCCS Arcispedale S.M.N, Via Risorgimento 80, 42120 Reggio Emilia, Italy. Electronic address: giuseppe.falco@asmn.re.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Falco
authors.affiliation: Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University Federico II of Naples, Italy; University of Milan, Italy. Electronic address: nicolarocco2003@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rocco
authors.affiliation: Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University Federico II of Naples, Italy. Electronic address: antonello.accurso@unina.it.
authors.forename: Antonello
authors.initials: A
authors.lastname: Accurso
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology*; D001706:Biopsy / Q000379:methods*; D002908:Chronic Disease; D015331:Cohort Studies; D046508:Culture Techniques; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D007507:Therapeutic Irrigation / Q000379:methods*; D014947:Wounds and Injuries / Q000150:complications / Q000382:microbiology*
keywords: Chronic wounds; Infection; VERSAJET