Diagnostic validity of three swab techniques for identifying chronic wound infection

Authors: Gardner, Sue E.; Frantz, Rita A.¹; Saltzman, Charles L.²; Hillis, Stephen L.³; Park, Heeok¹; Scherubel, Melody⁴

Source: Wound Repair and Regeneration, Volume 14, Number 5, September-October 2006 , pp. 548-557(10)

Publisher: Wiley-Blackwell

Abstract:

This study examined the diagnostic validity of three different swab techniques in identifying chronic wound infection. Concurrent swab specimens of chronic wounds were obtained using wound exudate, the Z-technique, and the Levine technique, along with a specimen of viable wound tissue. Swab and tissue specimens were cultured using quantitative and qualitative laboratory procedures. Infected wounds were defined as those containing 1 × 10⁶ or more organisms per gram of tissue. Accuracy was determined by associating the quantitative cultures of swab specimens with the cultures from tissue specimens using receiver operating characteristic curves. Of the 83 study wounds, 30 (36%) were infected. Accuracy was the highest for swab specimens obtained using Levine's technique at 0.80. Based on Levine's technique, a critical threshold of 37,000 organisms per swab provided a sensitivity of 90% and a specificity of 57%. The mean concordance between swab specimens obtained using Levine's technique and tissue specimens was 78%. The findings suggest that swab specimens collected using Levine's technique provide a reasonably accurate measure of wound bioburden, given that they are more widely applicable than tissue cultures. The diagnostic validity of Levine's technique needs further study using an alternative reference standard, such as the development of infection-related complications.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1743-6109.2006.00162.x

Affiliations: 1: The University of Iowa College of Nursing, 2: The University of Iowa College of Medicine, and 3: Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, 4: Iowa City VA Medical Center, Iowa City, Iowa

Publication date: 2006-09-01

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