Consensus recommendation: Indications and methods for microbiological wound diagnostics

Aim

To describe the indication and technique of microbiological wound investigation in treating infected or colonised wounds with or without multi-drug resistant microorganisms (MDROs). The clinical symptoms and criteria of locally or systemically infected wounds are summarized and described.

Method

An interdisciplinary consensus of microbiological wound diagnosis was elaborated between representatives of different medical specialities. Moreover, some perspectives on future wound diagnostics were presented.

Results

The panel agreed on ten clinical signs, situations and symptoms, which give the indication for further microbiological wound investigation: formation of pus, clinical signs or suspicion of an infection, suspicion or presence of a surgical site infection, localised progredient infection with or without systemic involvement (e.g. joint empyema, phlegmone), gangrene formation and necrotising fasciitis, ulcerative neoplasia, burn wounds with > 15% thermally injured surface area, exacerbation of dermatological disorders, localised wound infection without sign of systemic involvement after 3 days treatment with antiseptics without obvious clinical improvement, and chronic skin lesion with indication to screen for MDROs.

The panel agreed that no indication for microbiological investigation is given in acute wounds without signs of infection and uncomplicated superficial wounds.

Today, the gold standard for microbiological investigation is processing tissue biopsies in the laboratory. However, in many instances it may be easier and more rapid to perform a wound swab. If swabs are obtained, the Essener circle or the Levine technique shall be applied. Wound swabs, however, are the method of choice in screening for wound colonisation with MDROs. Additionally, information is summarised pertaining to transport and processing of microbiological wound specimens Also, potential applicability of future wound diagnostic methods based on genomic, metabolomic and proteomic approach are discussed.

Conclusion

Beside a full understanding of all clinical symptoms and clinical experience of wound experts the correct microbiological wound investigation will be the basis for a succesfull management of infected wounds.