Stallard Y
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy an.... Date of publication 2018 Mar 1;volume 45(2):179-186.
1. J Wound Ostomy Continence Nurs. 2018 Mar/Apr;45(2):179-186. doi:
10.1097/WON.0000000000000414.
When and How to Perform Cultures on Chronic Wounds?
Stallard Y(1).
Author information:
(1)Yvonne Stallard, MS, RN, CWCN, Swedish Covenant Hospital, Chicago, Illinois.
PURPOSE: The purpose of this Evidence-Based Report Card was to examine current
best evidence related to when and how to perform cultures on chronic wounds to
guide clinicians in determining the appropriate treatment.
QUESTION: (1) When should cultures be performed on chronic wounds? and (2) What
is the best method or technique to perform a culture on a chronic wound?
SEARCH STRATEGY: A search of the literature was performed, resulting in 45
publications relevant to the topic. Following a review of titles and abstracts, 7
studies were identified that met inclusion criteria. Key search terms used were
"chronic wound," "chronic infected wound," "wound culture," "specimen
collection," and "wound swab." Strength of the evidence was rated based on the
methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center
for Evidence-Based Medicine, adapted by Gray and colleagues.
FINDINGS: Seven studies were identified as pertinent to the topic on wound
culture and meeting inclusion criteria. The study designs included 1 randomized
controlled trial, 1 quasi-experimental comparative study, 1 systematic review, 1
scoping literature review, 1 integrative literature review, and 2 professional
organization expert panel reviews (consensus statement and position statement).
Of the 7 studies, 3 studies suggest that classic signs of infection may not
always be present but culturing may be indicated when additional signs such as
pain, necrotic tissue, prolonged or delayed healing, and wound bed deterioration
occur. Four studies report that a quantitative culture of wound tissue is the
gold standard to obtain a wound culture, but the swab method is an acceptable
alternative option. Two articles demonstrate the Levine technique is more
reliable than the Z-technique to determine microbial load in the wound bed. The
strength of the evidence was identified as 2 level A studies, 1 level B study,
and 4 level C studies. Using Johns Hopkins methodology, the quality of the
studies was deemed either high quality or good quality.
CONCLUSION/RECOMMENDATION: Evidence indicates that identification of potential
chronic wound infection should be considered early using clinical signs such as
pain, necrotic tissue, delayed healing, and wound deterioration (in addition to
classic signs of infection) to determine the need for collecting a culture
(Strength of Recommendation Taxonomy [SORT] level 2); and when a culture is
deemed necessary, swab culture using the Levine method is a clinically practical
alternative if performed correctly (SORT level 1).
DOI: 10.1097/WON.0000000000000414
PMID: 29521930 [Indexed for MEDLINE]
