Nelson, E orcid.org/0000-0001-6741-3078, Wright-Hughes, A orcid.org/0000-0001-8839-6756, Backhouse, MR orcid.org/0000-0003-0056-8467 et al. (5 more authors) (2018) CODIFI (Concordance in Diabetic Foot Ulcer Infection): a cross-sectional study of wound swab versus tissue sampling in infected diabetic foot ulcers in England. BMJ Open, 8 (1). e019437. ISSN 2044-6055
Abstract
Objective: To determine the extent of agreement and patterns of disagreement between wound swab and tissue samples in patients with an infected diabetic foot ulcer (DFU). Design: Multi-centre, prospective, cross-sectional study. Setting: Primary and secondary care foot ulcer/diabetic outpatient clinics and hospital wards across England.
Participants: Inclusion criteria: Consenting patients aged ≥18 years; diabetes mellitus; suspected infected DFU. Exclusion criteria: Clinically inappropriate to take either sample. Interventions: Wound swab obtained using Levine’s technique; tissue samples collected using a sterile dermal curette or scalpel. Outcome measures: Co-primary: Reported presence, and number, of pathogens per sample; prevalence of resistance to antimicrobials among likely pathogens. Secondary: Recommended change in antibiotic therapy based on blinded clinical review; adverse events; and, sampling costs. Results: 400 consenting patients (79% male) from 25 centres. Most prevalent reported pathogens were Staphylococcus aureus (43.8%), Streptococcus (16.7%), and other aerobic gram-positive cocci (70.6%). At least one potential pathogen was reported from 70.1% of wound swab and 86.1% of tissue samples. Pathogen results differed between sampling method in 58% of patients, with more pathogens and fewer contaminants reported from tissues.
The majority of pathogens were reported significantly more frequently in tissue than wound swab samples (p<0.01); with equal disagreement for Staphylococcus aureus and Pseudomonas aeruginosa. Blinded clinicians more often recommended a change in antibiotic regimen based on tissue compared with wound swab results (increase of 8.9%, 95% CI:2.65,15.3%). Ulcer pain and bleeding occurred more often after tissue collection versus wound swabs (pain: 9.3%,1.3%; bleeding: 6.8%,1.5%, respectively). Conclusion: Reports of tissue samples more frequently identified pathogens, and less frequently identified non-pathogens compared with wound swab samples. Blinded clinicians more often recommended changes in antibiotic therapy based on tissue compared with wound swab specimens. Further research is needed to determine the effect of the additional information provided by tissue samples. Trial registration number ISRCTN52608451.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Healthcare (Leeds) > Nursing Adult (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research 006/725 NIHR National Inst Health Research 09/75 |
Depositing User: | Symplectic Publications |
Date Deposited: | 03 Jan 2018 13:02 |
Last Modified: | 05 Oct 2020 15:16 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Identification Number: | 10.1136/bmjopen-2017-019437 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:125683 |