What are examples of orders for a wound culture and sensitivity?

Wound Culture and Sensitivity Order Examples

For infected wounds requiring culture, order tissue specimens obtained by curettage or biopsy from the debrided wound base, sent in sterile transport containers for aerobic and anaerobic culture with antimicrobial sensitivity testing, accompanied by clinical information including specimen type, anatomic location, and current antibiotic use. 1

When to Order Wound Cultures

• Order cultures for infected wounds to guide antibiotic selection, particularly for moderate to severe infections 1
• Do NOT culture clinically uninfected wounds unless performing infection-control surveillance 1
• Cultures may be unnecessary for acute mild infections in antibiotic-naive patients 1
• Order blood cultures for severe infections, especially when the patient is systemically ill 1

Specimen Collection Protocol

Pre-Collection Steps

• Cleanse and debride the wound thoroughly before obtaining any specimen 1
• Remove all necrotic tissue and purulent material first 1

Preferred Collection Method: Tissue Specimens

• Obtain tissue from the debrided wound base using curettage (scraping with sterile dermal curette or scalpel blade) or biopsy (bedside or operative) 1
• Tissue specimens are superior to swabs with higher sensitivity and specificity 1
• Deep tissue specimens contain only true pathogens, while superficial swabs yield mixtures of pathogens, colonizers, and contaminants 1

Alternative Collection Methods (When Tissue Unavailable)

• If swabbing is the only option, use a swab designed for both aerobic and anaerobic organisms from the debrided wound base only 1
• Avoid swabbing undebrided ulcers or wound drainage as this yields unreliable results 1
• Needle aspiration may be useful for purulent collections or cellulitis areas 1

Order Components

Essential Information to Include

• Specimen type: tissue biopsy, curettage specimen, or swab (specify if tissue unavailable) 1
• Anatomic location: precise wound location 1
• Type of infection: cellulitis, abscess, ulcer, surgical site 1
• Current antibiotic therapy: whether patient is taking antibiotics 1
• Request both aerobic and anaerobic culture with antimicrobial sensitivity testing 1

Transport Requirements

• Send specimens promptly in sterile transport containers or appropriate transport media 1
• Use proper transport media for anaerobic organisms 1

Example Order Formats

Example 1 (Preferred - Tissue Specimen): "Wound culture and sensitivity: Tissue specimen obtained by curettage from debrided base of left foot diabetic ulcer. Send in sterile container for aerobic and anaerobic culture with antimicrobial sensitivity testing. Patient currently on cephalexin."

Example 2 (Severe Infection): "Wound culture and sensitivity: Tissue biopsy from right lower extremity abscess. Blood cultures x2 sets. Send wound specimen for aerobic and anaerobic culture with antimicrobial sensitivity testing. Patient febrile with systemic signs of infection."

Example 3 (When Only Swab Available): "Wound culture and sensitivity: Swab from debrided base of sacral pressure ulcer (tissue specimen not obtainable). Use aerobic and anaerobic transport system. Send for culture with antimicrobial sensitivity testing. No current antibiotics."

Common Pitfalls to Avoid

• Never culture undebrided wounds - this yields contaminated results with multiple organisms that don't represent true pathogens 1
• Don't repeat cultures unless the patient fails to respond clinically to treatment 1
• Avoid relying on swab cultures alone when tissue specimens are obtainable 1, 2
• Multiple organisms (especially 8+ different species) strongly suggest contamination rather than true infection 3
• Don't culture wound drainage or exudate - these are invariably contaminated 1

Laboratory Processing Expectations

• Traditional phenotypic culture takes 2+ days for results 1
• Cultures will identify common aerobic Gram-positive cocci (staphylococci, streptococci), Gram-negative rods (Enterobacteriaceae, Pseudomonas), and anaerobes (peptostreptococci, Bacteroides) 1
• Molecular/genotypic testing (PCR) can provide results within 4-6 hours with higher sensitivity but is more expensive 1, 4