title: Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of Skin and Soft Tissue Infections (SSTIs).
abstract: Thirty-two patients affected by SSTIs including DFIs were enrolled between 2013 and 2014. Superficial swab was obtained before and after cleansing with sterile saline, and after ultrasonic debridement; deep tissue biopsy was obtained from ulcer base. Samples were diluted with 1 mL of saline, serial 10-fold dilutions to 10-6were made and 50 μL of each dilution was plated onto appropriate media. Bacteria were identified by Vitek II system. Microbial load was expressed as CFU/mL. Statistical analysis was performed by χ2. Incidence of Gram positives was higher than Gram negatives (S. aureus and P. aeruginosa being the most frequent); concordance (same bacteria isolated before and after debridement) never exceeded 60%. Ultrasonic debridement significantly reduced bacterial load or even suppressed bacterial growth. While reliability of superficial swab is poor for microbiological diagnosis of SSTIs, swabbing after ultrasonic debridement and biopsy of the ulcer base may be equally reliable.
authors.affiliation: a Department of Infectious Diseases , University of Salerno , Salerno , Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Esposito
authors.affiliation: a Department of Infectious Diseases , University of Salerno , Salerno , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Simone
authors.affiliation: a Department of Infectious Diseases , University of Salerno , Salerno , Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Gioia
authors.affiliation: a Department of Infectious Diseases , University of Salerno , Salerno , Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Noviello
authors.affiliation: b Department of Plastic Surgery , University of Salerno , Salerno , Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Pagliara
authors.affiliation: b Department of Plastic Surgery , University of Salerno , Salerno , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Campitiello
authors.affiliation: b Department of Plastic Surgery , University of Salerno , Salerno , Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Rubino
authors.affiliation: c Hyperbaric Therapy Unit , AOU San Giovanni di Dio e Ruggi d'Aragona , Salerno , Italy.
authors.forename: Dante
authors.initials: D
authors.lastname: Lo Pardo
authors.affiliation: d Hygiene Unit , University of Salerno , Salerno , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Boccia
authors.affiliation: d Hygiene Unit , University of Salerno , Salerno , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Caro
authors.affiliation: e Department of Infectious Diseases , Ospedale Cotugno , Naples , Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Ascione
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058491:Bacterial Load / Q000528:radiation effects; D001706:Biopsy; D003646:Debridement; D017719:Diabetic Foot / Q000150:complications / Q000382:microbiology / Q000628:therapy; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011550:Pseudomonas aeruginosa / Q000254:growth & development / Q000302:isolation & purification* / Q000528:radiation effects; D012017:Referral and Consultation; D017192:Skin Diseases, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D012883:Skin Ulcer / Q000150:complications / Q000382:microbiology / Q000628:therapy; D018461:Soft Tissue Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000254:growth & development / Q000302:isolation & purification* / Q000528:radiation effects; D000069453:Ultrasonic Waves
keywords: Biopsy; SSTIs; Swab cultures