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Hi Everyone,
An amazing session by Jim Gauthier (international speaker) on diagnostic stewardship this month – if you missed the sessions its a must to see the recording: https://www.acipc.org.au/acipc-aged-ipc-webinar-series/diagnostic-stewardship-from-swab-to-requisition/
The Q&A from this session that were not addressed due to time are provided below:
1. Generally, wound swab is not recommended for pressure injuries. How about suspected infection for PI 2-4? Because wound specialists, GPs and NPs requests for swab to be completed.
A. I found the included (link below) paper that indicates if an infection is suspected to be spreading or systemic, to debride first, then culture. See the flowchart in the paper (Visconti). Link: https://pubmed.ncbi.nlm.nih.gov/37590857/
2. If a urine MCS came back with fungal organism. Should the patient be treated with antifungal or do a vaginal swab? Symptoms are dysuria, and vaginal itchiness.
A. I would be tempted to do the vaginal swab, indicating fungal culture, and to repeat the urine culture ensuring the collection is midstream or in/out catheter.. Pushing fluids (if tolerated) is always a great first step for dysuria (that is part of my pathophysiology presentation).
3. Should we wet the swab first before taking MRSA swab?
A.Depends where you are swabbing. If it is a dry surface like intact skin, or nares, then yes. If you are swabbing open skin, mucous membrane: then it would not be required.
4. How long after using the antifungal with no healing would you recommend swabbing to rule out candida aureus?
A. If there is no resolution of the lesion, I would recommend wait 48 hours then swab with a request to rule out Candidozyma auris (new name!). You could also consider a fungal scraping to rule out another mycosis. Or, if possible, a skin biopsy to check for other underlying causes (scabies, impetigo, etc.).
5. Hi team this is a great presentation and as an IPC lead for our aged care organisation, think it would be a great presentation to make available for our local GP’s, who are our primary prescribers. Am I able to share the presentation.
A. Everyone is welcome to attend the webinars, they are free to access – feel free to invite and share the rego links/website. The webinars are recorded and are available on the ACIPC website in the aged care space. https://www.acipc.org.au/acipc-aged-ipc-webinar-series/
