Professional Documents
Culture Documents
Wound Infection
Wound Infection
In many cases there is a mixed infection with more than one bacterial spp.
wounds
Wound infections may be endogenous or exogenous.
Endogenous infections are caused by organisms that are in commensal in the patient . Exogenous infections the source is out of the body cross-infection is a particular example.the causal organism is spread from person to person. infection may occur after accidental or intentional trauma of the skin or tissue. (Surgical postoperative sepsis. )
Wounds are liable to contamination with a multiplicity of organisms from the body surfaces and environment.
Infection of a wound is difficult to define , and no clear rules can be given to distinguish it from colonization and contamination.
Contamination
The contaminating organisms are present in small numbers
Colonization
In the case of commensal or low grade pathogenes it can be described colonization.
Infection
Infection occurs when they evades the host defences.replicates in large numbers and attacks the host tissue.
Wounds:Classification
Acute
Caused by external damage to intact skin
Chronic
Precipitated by predisposing conditions that lead to compromise of dermal/epidermal tissue
Types
Surgical Bites Burns Minor cuts Abrasions Severe traumatic
Types
Impaired venous drainage Impaired arterial supply Metabolic diseases eg. diabetes
Bite wounds
Special pathogens: Pasteurella muftocida, Capnocytophaga canimorsus, Bartonella henselae, Eikenelfa corrodens Other mixed aerobes and anaerobes
Decubitus ulcers
Mixed aerobic and anaerobic bacteria
SAMPLING
Biopsy
SAMPLING
SAMPLING
Delay in the transit of specimen to the laboratory must be avoided.especially swabs where the exudate may dry.
CONTINUE
If the swab is dry, moisture it well with a little sterile broth or saline . the examination of material on swabs for mycobacteria is always unsatisfactory.
Physicians should be instructed that when a special investigation is required ,they usually should state on the request form.
SAMPLING
Wound Cultures
For closed Wounds
Prepared site as described for obtaining Blood Culture Aspirate as much purulant material as possible Transport in aerobic /anaerobic transport media
Laboratory examination
Special methods of examination should be applied to particular specimens. the basic procedures usually include
Naked eye examination, (for macroscopy criteria ,such as color , odor consistency,..) The microscopical examination, Culture on aerobic and anaerobic blood agar plates, on MacConkey agar and in cooked meat broth .
Microscopy
Much useful information may be obtained from smear by Gram-staining. We should notice
presence and relative numbers of PMNs , SEC and bacteria morphology of Gram positive or Gram negative bacteria. Examination of a wet film for fungi or motile bacteria. A smear stained by the Ziehl- Neelsen method should be examined when the clinical circumstances suggest the tubercle bacillus., another mycobacterium or a nocardia may be present
Wound Cultures
Culture for aerobic and anaerobic bacteria if appropriately collected
Gram stain results suggest adequate collection or presence of inflammation Tissues or aspirates vs. swabs Primary plating media: 5% SBA, Choc agar, MacConkey agar; anaerobic plates and thio if appropriately collected
Identify anaerobes to Genus level only Perform susceptibility testing of predominant organisms only
CULTURE
the specimen should be inoculated on two plates of blood agar (SBA 5%),
the one for incubation at 37c, 5-10% CO2.,for 1824h. The other for incubation anaerobically .
It should also be plated on Mac Conkey or CLED agar, for identification of coliforms , staphylococci ,
enterococci, also be inoculated into a tube of cooked meat broth for the enrichment of exacting aerobes and anaerobes.
CULTURE
Colonies should be noted and more tests for identification and antibiotic susceptibility tests done. If there is no growth after 24h ,all plates should be reincubated for another 24h for slow-growing pathogen such as Actinomyces israeli or some species of bacteroides it should be incubated longer for about 7 days.
CULTURE
if at 24 h or 48 h there is growth on cookedmeat broth , but no growth on the plates , the broth should be filmed and subcultured. if tuberculous or fungal infection is suspected , the specimen should be cultured by the appropriate methods on special media.
Work up any potential pathogens to maximum of three, list others present by morphology Work up any quantity S. aureus, P. aeruginosa, beta hemolytic streptococci, enterics and gram-negative anaerobes
Work up (identify and perform susceptibility testing): Gram positive cocci in clusters and gram neg bacilli Culture report: Many S. aureus, many Klebsiella pneumoniae, light aerobic bacteria resembling skin flora
4PP
Morph ID only
But a pure growth of a commensal from an aspirated deep wound is not contamination and should be reported with AST performance.
In general, a numerous or predominant organism is likely to have pathogenic significance.
But the relative numbers of the colonies of the different organisms on a culture plate may not reflect the relative numbers of the organisms in the lesion .for they are subject to many variations such as the relative speed of growth of different species., antibiotic interactions between different species and the greater tendency of the more delicate pathogenes to die during transport of specimens. For such reason a causal pathogen may be cultured in smaller numbers than a contaminating commensal.