Concordance of molecular microbiology and conventional culture techniques for infected diabetic foot ulcer management

IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Angela Oates, Sarah T. Brown, Colin C. Everett, Fran Game, Jane E. Nixon, Tim Sloan, Michelle M. Lister, Michael Backhouse, Benjamin A. Lipsky, David Russell, Howard Collier, Joanna Dennett, Rachael Gilberts, E. Andrea Nelson
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Abstract

Aim

The management of infected diabetic foot ulcers (DFUs) requires balancing the need for timely interventions against the desire for targeted antibiotic therapy, which relies on laboratory results. This study aimed to evaluate concordance between molecular and conventional culture and sensitivity (C&S) methods in identifying bacteria from infected DFUs.

Methods

This study was conducted alongside CODIFI2, a Phase III randomised controlled trial comparing tissue sampling with wound swabbing. It assessed C&S and metagenomic 16S rRNA gene sequencing (M16S) in DFUs with suspected mild or moderate infections using both tissue and swab samples.

Results

In 145 participants, C&S identified 248 microorganisms across 25 genera including eight anaerobic genera. M16S identified a greater number and diversity of microorganisms, detecting 455 across 40 genera, including 173 anaerobes from 15 distinct genera. No bacterial growth was reported in 25.5% (95% CI: 18.0%–32.3%) of C&S samples, whereas M16S identified at least one organism in all samples. While the observed agreement between methods was high (75%), Cohen's Kappa revealed low concordance overall, except for Pseudomonas spp. and Streptococcus spp. (Kappa ≥ 0.5).

Conclusions

M16S detected a broader microbial spectrum, including fastidious anaerobes, but its low concordance with C&S and lack of antibiotic sensitivity data, challenge its suitability as a replacement for C&S in mild or moderate DFU infections. It may offer advantages in infections where increased sensitivity is beneficial, particularly where extended culture approaches are recommended to detect fastidious or low-abundance organisms. For mild to moderate DFU infections, our findings support continued reliance on conventional C&S testing.

分子微生物学与常规培养技术在糖尿病足溃疡治疗中的一致性。
目的:感染糖尿病足溃疡(DFUs)的管理需要平衡及时干预的需要和靶向抗生素治疗的愿望,这依赖于实验室结果。本研究旨在评价分子培养法与常规培养法和敏感性(C&S)方法在鉴定感染dfu细菌方面的一致性。方法:本研究与CODIFI2一起进行,CODIFI2是一项比较组织取样和伤口拭子的III期随机对照试验。使用组织和拭子样本评估疑似轻度或中度感染的DFUs的C&S和宏基因组16S rRNA基因测序(M16S)。结果:在145名参与者中,C&S鉴定了25个属的248种微生物,其中包括8个厌氧属。M16S检测到的微生物数量和多样性更高,共检测到40属455种,其中厌氧菌173种,来自15个不同的属。25.5% (95% CI: 18.0%-32.3%)的C&S样品未发现细菌生长,而M16S在所有样品中至少鉴定出一种微生物。虽然观察到的方法之间的一致性很高(75%),但Cohen's Kappa显示,除了假单胞菌和链球菌外,总体一致性较低(Kappa≥0.5)。结论:M16S检测到更广泛的微生物谱,包括挑剔的厌氧菌,但其与C&S的一致性较低,缺乏抗生素敏感性数据,挑战了其在轻中度DFU感染中替代C&S的适用性。它可能在提高敏感性有益的感染中提供优势,特别是在推荐扩展培养方法以检测挑剔或低丰度生物体的情况下。对于轻度至中度DFU感染,我们的研究结果支持继续依赖传统的C&S检测。
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来源期刊
Diabetic Medicine
Diabetic Medicine 医学-内分泌学与代谢
CiteScore
7.20
自引率
5.70%
发文量
229
审稿时长
3-6 weeks
期刊介绍: Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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