CODIFI (Concordance in Diabetic Foot Ulcer Infection): a cross-sectional study of wound swab versus tissue sampling in infected diabetic foot ulcers in England.
CODIFI (Concordance in Diabetic Foot Ulcer Infection): a cross-sectional study of wound swab versus tissue sampling in infected diabetic foot ulcers in England.
复制标题
DOI：
10.1136/bmjopen-2017-019437
复制
发表时间：
2018-01-31
期刊：
影响因子：
2.9
通讯作者：
CODIFI collaborators
中科院分区：
文献类型：
--
作者：
Nelson A;Wright-Hughes A;Backhouse MR;Lipsky BA;Nixon J;Bhogal MS;Reynolds C;Brown S;CODIFI collaborators
确定感染糖尿病足溃疡（DFU）患者的伤口拭子和组织样本之间的一致程度和不一致模式。多中心、前瞻性、横断面研究。初级和二级护理足溃疡/糖尿病门诊诊所和整个英格兰的医院病房。纳入标准：年龄≥18岁的自愿患者；糖尿病;疑似感染DFU。排除标准：临床不适宜采集任一样本。使用Levine技术获得的伤口拭子；用无菌皮肤刮刀或手术刀收集组织样本。初级：每个样本报告的病原体存在和数量；可能的病原体中抗微生物药物耐药性的流行情况。其次：基于盲法临床评价的抗生素治疗建议改变；不良事件;抽样成本。来自25个中心的400名同意患者（79%为男性）。病原菌以金黄色葡萄球菌（43.8%）、链球菌（16.7%）和其他需氧革兰氏阳性球菌（70.6%）为主。70.1%的伤口拭子和86.1%的组织样本至少报告了一种潜在病原体。在58%的患者中，不同采样方法的病原体结果不同，组织标本中报告的病原体较多，污染物较少。大多数病原体在组织中报告的频率明显高于伤口拭子样本（P<0.01），金黄色葡萄球菌和铜绿假单胞菌的差异相同。与伤口拭子结果相比，盲法临床医生更经常建议根据组织改变抗生素方案（增加8.9%,95% CI 2.65%至15.3%）。与伤口拭子相比，组织采集后溃疡疼痛和出血更常发生（疼痛：9.3%,1.3%；出血：6.8%,1.5%）。与伤口拭子样本相比，组织样本报告更频繁地发现病原体，而较少地发现非病原体。与伤口拭子标本相比，盲法临床医生更经常建议根据组织改变抗生素治疗。需要进一步的研究来确定组织样本提供的额外信息的影响。ISRCTN52608451。
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). Multicentre, prospective, cross-sectional study. Primary and secondary care foot ulcer/diabetic outpatient clinics and hospital wards across England. Inclusion criteria: consenting patients aged ≥18 years; diabetes mellitus; suspected infected DFU. Exclusion criteria: clinically inappropriate to take either sample. Wound swab obtained using Levine’s technique; tissue samples collected using a sterile dermal curette or scalpel. Coprimary: 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; sampling costs. 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 methods in 58% of patients, with more pathogens and fewer contaminants reported from tissue specimens. The majority of pathogens were reported significantly more frequently in tissue than wound swab samples (P<0.01), with equal disagreement for S. 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% to 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). 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. ISRCTN52608451.
登录
查看更多内容
影响因子：
3.5
作者：
Slater, RA;Lazarovitch, T;Rapoport, MJ
通讯作者：
Rapoport, MJ
影响因子：
120.7
作者：
Menke, Andy;Casagrande, Sarah;Cowie, Catherine C.
通讯作者：
Cowie, Catherine C.
DOI：
10.1097/00005373-197602000-00002
发表时间：
1976-01-01
影响因子：
--
作者：
LEVINE, NS;LINDBERG, RB;PRUITT, BA
通讯作者：
PRUITT, BA
影响因子：
11.8
作者：
Lipsky, Benjamin A.;Berendt, Anthony R.;Senneville, Eric
通讯作者：
Senneville, Eric
影响因子：
3
作者：
Mutluoglu, Mesut;Uzun, Gunalp;Lipsky, Benjamin A.
通讯作者：
Lipsky, Benjamin A.