What is the appropriate wording for a skin culture order, including specimen type, collection site, clinical context, and handling instructions?

Skin Culture Order: Essential Components

For a skin culture order, write: "Aerobic and anaerobic bacterial culture with Gram stain from [specific anatomic site], collected via tissue biopsy/curettage from debrided wound base" and include relevant clinical context such as suspected infection type, recent antibiotic exposure, and risk factors for resistant organisms. 1, 2

Critical Order Components

Specimen Type Specification

• Request tissue specimen as first choice via curettage (scraping with sterile dermal curette or scalpel blade from wound base) or tissue biopsy, as these provide superior pathogen identification compared to swabs 1, 2, 3
• If tissue cannot be obtained, specify flocked swabs (not standard swabs) as they optimize specimen collection and minimize material entrapment 1, 2
• For purulent material, request needle aspiration using sterile needle and syringe 1, 2

Culture Type Requirements

• Always specify both aerobic AND anaerobic culture unless you have specific reason to exclude anaerobes, as skin infections are frequently polymicrobial 1, 2
• Request Gram stain alongside culture to evaluate specimen adequacy, provide early presumptive diagnosis, and identify mixed infections 2, 3

Anatomic Site Documentation

• Document the exact anatomic location (e.g., "right lateral malleolus," "left buttock pressure ulcer") rather than vague terms like "leg wound" 1
• Specify if the site is a pressure ulcer, diabetic foot ulcer, surgical site, or other wound type as this guides laboratory interpretation 1, 3

Essential Clinical Context

Infection Severity and Characteristics

• State whether infection is mild, moderate, or severe based on extent of cellulitis, presence of systemic signs, or deep tissue involvement 1, 4
• Note presence of purulent drainage, necrotic tissue, or exposed bone as these findings alter specimen collection approach 1, 3

Antibiotic History and Resistance Risk

• Document recent antibiotic exposure (type and duration) as this dramatically affects pathogen recovery and resistance patterns 1, 3
• Indicate risk factors for MRSA (prior MRSA history, high local prevalence, healthcare exposure) or other resistant organisms like ESBL-producing gram-negatives 1, 3
• For chronic infections or previously treated wounds, explicitly state this as polymicrobial and resistant organisms are more likely 1, 3

Pre-Collection Requirements to Document

Wound Preparation Status

• Confirm that wound was cleansed and debrided prior to specimen collection to avoid contamination with surface colonizers 1, 2, 3
• If specimen obtained during surgical debridement, note this as intraoperative specimens are optimal 1, 3

Timing Relative to Antibiotics

• Specify if specimen collected before or after antibiotic initiation, as pre-antibiotic specimens are strongly preferred when resistant organisms are suspected 1, 3

Transport and Handling Instructions

Container and Transport Medium

• For tissue/fluid: sterile container or sterile anaerobic container for combined aerobic/anaerobic culture 1, 2
• For swabs: anaerobic swab transport device if anaerobes suspected 1, 2
• Never use standard swab transport for anaerobic cultures as this kills obligate anaerobes 2

Temperature and Timing

• Transport at room temperature (not refrigerated, not on ice) 1, 2
• Deliver to laboratory within 2 hours for optimal results, or immediately for tissue specimens 1, 2

Common Pitfalls to Avoid

• Never order cultures from clinically uninfected wounds unless for specific epidemiological surveillance purposes 1, 3
• Do not accept swab specimens from non-debrided wounds as these only identify colonizers, not true pathogens 1, 3
• Avoid ordering "wound culture" without specifying aerobic vs anaerobic as laboratories may default to aerobic-only 1, 2
• Do not culture superficial wound drainage or exudate as this provides misleading results 1, 3

Example Order Format

"Aerobic and anaerobic bacterial culture with Gram stain. Specimen: tissue obtained by curettage from debrided base of right heel diabetic foot ulcer (Wagner grade 3). Clinical context: moderate infection with 3cm surrounding erythema, purulent drainage, no systemic signs. Patient received cephalexin x 5 days prior to specimen collection. Risk factors: prior MRSA cellulitis 6 months ago. Transport in sterile anaerobic container at room temperature within 2 hours." 1, 2, 3