Volume 13, Issue 1
Original Article / Published: September 2025
DOI: https://www.doi.org/10.57045/jemis/1310925.pp25-33
I.Gergova1, T. Badarov 2
1Microbiology Laboratory, Department of Microbiоlogy, Virology, Clinical laboratory and Immunology, Military Medical Academy of Sofia, 2Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgari Clinic of Thoracic surgery, Department of Thoracic Surgery, Pneumology, Phthisiology and Endocrinology, and Metabolic Diseases, Military Medical Academy of Sofia
Abstract
This review examines the critical factors involved in the development of soft tissue infections and their influence on the prognosis of wound healing. It provides a comparative analysis of commonly used quantitative and qualitative microbiological methods, focusing on their diagnostic value in detecting infection and predicting healing outcomes. Furthermore, the review evaluates the effectiveness of both invasive and non-invasive specimen collection techniques in suspected soft tissue infections, with respect to the diagnostic reliability of the obtained samples.
References
1.Armstrong, D. G., P. J. Liswood, and W. F. Todd. Prevalence of mixed infections in the diabetic pedal wound. A retrospective review of 112 infections. J. Am. Podiatr. Med. Asoc., 1995,
85:533–537.
2. Bagdade, J. D., R. K. Root, and R. J. Bulger. Impaired leukocyte function in patients with poorly controlled diabetes. Diabetes, 1974, 23:9–15.
3. Bartlett, J. G., and S. L. Gorbach. Anaerobic infections of the head and neck. Otolaryngol. Clin. North Am., 1976, 9:655–678.
4. Bendy, R. H., P. A. Nuccio, E. Wolfe, B. Collins, C. Tamburro, W. Glass, and C. M. Martin. Relationship of quantitative wound bacterial counts to healing of decubiti. Effect of topical gentamicin. Antimicrob. Agents Chemother, 1964, 4:147–155.
5. Bornside, G. H., and B. B. Bornside. Comparison between moist swab and tissu biopsy methods for quantitation of bacteria in experimental incisional wounds. J. Trauma, 1979, 19:103–105.
6. Bowler, P. G. The anaerobic and aerobic microbiology of wounds: a review. Wounds, 1998, 10:170–178.
7. Bowler, P. G. The prevalence and significance of anaerobic bacteria in wounds. M.Phil. thesis. University of Wales College of Medicine, Cardoff, United Kingdom, 1999.
8. Bowler, P. G., and B. J. Davies. The microbiology of acute and chronic wounds. Wounds, 1999, 11:72–79.
9. Bowler, P. G., and B. J. Davies. The microbiology of infected and noninfected leg ulcers. Int. J. Dermatol., 1999. 38:101– 106.
10. Breidenbach, W. C., and S. Trager. Quantitative culture technique and infection in comp, ex wounds of the extremities closed with free flaps. Plast. Reconstr. Surg., 1995.95:860–865.
11.Brook, I. A 12 year study of the aerobic and anaerobic bacteria in intra-abdominal and postsurgical abdominal wound infections. Surg. Gynecol. Obstet., 1989, 169:387–392.
12. Brook, I. Aerobic and anaerobic microbiology of Bartholin’s abscess. Surg. Gynecol. Obstet., 1989, 169:32–34.
13. Brook, I. Microbiological studies of decubitus ulcers in children. J. Pediatr. Surg., 1991, 26:207–209.
14. Brook, I. Microbiology of gastrostomy site wound infections in children. J. Med. Microbiol., 1995, 43:221–223.
15. Brook, I. Aerobic and anaerobic microbiology of necrotising fasciitis in children. Pediatr. Dermatol., 1996, 13:281–284.
16. Brook, I., and S. M. Finegold. Aerobic and anaerobic bacteriology of cutaneous abscesses in children. Pediatrics, 1981,67:891–895.
17. Celikkol-Aydin, S., Gaylarde, C. C., Lee, T., Melchers,R. E., Witt, D. L., and Beech, I. B. 16S rRNA gene profiling of planktonic and biofilm microbial populations in the Gulf of Guinea using Illumina NGS. Marine Environmental Research, 2016 (122):105–112.
18. Brook, I., and E. H. Frazier. Aerobic and anaerobic microbiology of chronic venous ulcers. Int. J. Dermatol., 1998, 37:426–428.
19. Brook, I., and E. H. Frazier. Aerobic and anaerobic microbiology of infection after trauma. Am. J. Emerg. Med., 1998,16:585–591.
20. Daltrey, D. C., B. Rhodes, and J. G. Chattwood. Investigation into the microbial flora of healing and non-healing decubitus ulcers. J. Clin. Pathol, 1981, 34:701–705.
21. Danielsen, L., E. Balslev, G. Do¨ring, N. Hoiby, S. M. Madsen,M. Ågren, H. K. Thomsen, H. H. S. Fos, and H. Westh. Ulcerbed infection. Report of a case of enlarging venous leg ulcer colonised by Pseudomonas aeruginosa. APMIS, 1998,106:721–726.
22. Di Rosa, R., E. Di Rosa, and G. Panichi. Anaerobic bacteria in postsurgical infections: isolation rate and antimicrobial susceptibility. J. Chemother., 1996, 8:91–95.
23. Duerden, B. I. Virulence factors in anaerobes. Clin. Infect. Dis.,1994, 18:S253–S259.
24. Dutta, J. K. 1998. Fulminant infection by uncommon organisms in animal bite wounds. Postgrad. Med. J. 74:611–612.
25. Gilliland, E. L., N. Nathwani, C. J. Dore, and J. D. Lewis. Bacterial colonization of leg ulcers and its effect on the success rate of skin grafting. Ann. R. Coll. Surg. Engl., 1988, 70:105–108.
26. Haleem,A., Schultz, J. S., Heilmann, K. P., Dohrn,C. L., Diekema, D. J., and Gardner, S. E. Concordance of nasal and diabetic foot ulcer staphylococcal colonization. Diagnostic Microbiology and Infection Disease, 2014 (79), 1: 85-89.
27. Hansis, M. Pathophysiology of infection – a theoretical approach. Injury, 1996, 27:S-C5–S-C8.
28. Heggers, J. P. Defining infection in chronic wounds: methodology. An historical review of the quantitative assessment of microbial flora in wounds. J. Wound Care, 1998, 7:452–456.
29.Heggers, J. P., M. C. Robson, and E. T. Doran. Quantitative assessment of bacterial contamination of open wounds by a slide technique. Trans. R. Soc. Trop. Med. Hyg., 1969, 63:532–534.
30. Ingham, H. R., D. Tharagonnet, P. R. Sisson, and J. B. Selkon. Inhibition of phagocytosis in vitro by obligate anaerobes. Lancet, 1977, ii:1252–1254.
31. Liang, C., Tseng, H.-C., Chen H.-M., et al. Diversity and enterotype in gut bacterial community of adults in Taiwan. BMC Genomics, 2017 (18): art.932.
32. Lawrence, J. C. The bacteriology of burns. J. Hosp. Infect.,1985, 6:3–17.
33. Lev, M., K. C. Keudell, and A. F. Milford. Succinate as a growth factor for Bacteroides melaninogenicus. J. Bacteriol., 1971, 108:175–178.
34. Levine, N. S., R. B. Lindberg, A. D. Mason, and B. A. Pruitt. The quantitative swab culture and smear: a quick simple method for determining the number of viable bacteria on open wounds. J. Trauma, 1976, 16:89–94.
35. MacDonald, J. B., S. S. Socransky, and R. J. Gibbons. 1963. Aspects of the pathogenesis of mixed anaerobic infections of mucous membranes. J. Dent. Res. 42:529–544.
36. Madsen, S. M., H. Westh, L. Danielsen, and V. T. Rosdahl. Bacterial colonisation and healing of venous leg ulcers. APMIS, 1996, 104:895–899.
37. Majewski, W., Z. Cybulski, M. Napierala, F. Pukacki, R. Staniszewski, K. Pietkiewicz, and S. Zapalski. The value of quantitative bacteriological investigations in the monitoring of treatment of ischaemic ulcerations of lower legs. Int. Angiol., 1995,14:381–384.
38. Mayhall, C. G. Surgical infections including burns, In R. P. Wenzel (ed.), Prevention and control of nosocomial infections, 2nd ed. 1993, The Williams & Wilkins Co., Baltimore, Md., 614–664.
39. Mayrand, D., and B. C. McBride. Ecological relationships of bacteria involved in a simple, mixed anaerobic infection. Infect. Immun., 1980, 27:44–50.
40. McKee, A. S., A. S. McDermaid, A. R. Baskerville, A. B. Dowsett, D. C. Ellwood, and P. D. Marsh. Effect of haemin on the physiology and virulence of Bacteroides gingivalis W50. Infect. Immun., 1986, 52:249–355.
41. Mousa, H. A. Aerobic, anaerobic and fungal burn wound infections. J. Hosp. Infect, 1997, 37:317–323.
42. Nichols, R. L., and J. W. Smith. Anaerobes from a surgical perspective. Clin. Infect. Dis., 1994, 18:S280–286.
43. Pallua, N., P. C. Fuchs, B. Hafemann, U. Vo¨lpel, M. Noah, and R. Lu¨tticken. A new technique for quantitative bacterial assess-ment on burn wounds by modified dermabrasion. J. Hosp. Infect., 1999, 42:329–337.
44. Pathare, N. A., A. Bal, G. V. Talvalkar, and D. U. Antani. Diabetic foot infections: a study of microorganisms associated with the different Wagner grades. Indian J. Pathol. Microbiol., 1998, 41:437–441.
45. Pruitt, B. A., Jr., A. T. McManus, S. H. Kim, and C. W. Goodwin. Burn wound infections: current status. World J. Surg., 1998, 22:135–145.
46. Raahave, D., A. Friis-Moller, K. Bjerre-Jespen, J. Thiis-Knudsen, and L. B. Rasmussen. The infective dose of aerobic and an- aerobic bacteria in postoperative wound sepsis. Arch. Surg., 1986, 21:924–929.
47. Rastegar Lari, A., H Bahrami Honar, and R. Alaghehbandan. Pseudomonas infections in Tohid Burn Centre, Iran., 1998, 24:637–641.
48. Regev, A., M. Weinberger, M. Fishman, Z. Samra, and S. D. Pitlik. Necrotising fasciitis caused by Staphylococcus aureus. Eur. J. Clin. Microbiol. Infect. Dis., 1998, 17:101–103.
49. Robson, M. C. Wound infection. A failure of wound healing caused by an imbalance of bacteria. Surg. Clin. North Am., 1997, 77:637–650.
50. Robson, M. C., and J. P. Heggers. Bacterial quantification of open wounds. Mil. Med., 1969, 134:19–24.
51. Robson, M. C., and J. P. Heggers. Delayed wound closures based on bacterial counts. J. Surg. Oncol., 1970, 2:379–383.
52. Robson, M. C., C. E. Lea, J. B. Dalton, and J. P. Heggers. Quanti- tative bacteriology and delayed wound closure. Surg. Forum, 1968, 19:501–502.
53. Rotstein, O. D., T. Vittorini, J. Kao, M. I. McBurney, P. E. Nasmith, and S. A. Grinstein. Soluble Bacteroides by-product impairs phagocyte killing of Escherichia coli by neutrophils. Infect. Immun., 1989, 57:745–753.
54. Rubinstein, A., and C. E. Pierce. Rapid healing of diabetic foot ulcers with meticulous blood glucose control. Acta Diabetol. Lat., 1988, 25:25–32.
55. Rubinstein, A., C. E. Pierce, and Z. Bloomgarden. Rapid healing of diabetic foot ulcers with subcutaneous insulin infu- sion. Am. J. Med., 1983, 75:161–166.
56. Sapico, F. L., V. J. Ginunas, M. Thornhill-Joynes, H. N. Canawati, D. A. Capen, N. E. Klein, S. Khawam, and J. Z. Montgomerie. Quantitative microbiology of pressure sores in different stag-es of healing. Diagn. Microbiol. Infect. Dis., 1986, 5:31–38.
57. Sapico, F. L., J. L. Witte, H. N. Canawati, J. Z. Montgomerie, and A. N. Bessman. The infected foot of the diabetic patient: quantitative microbiology and analysis of clinical features. Rev. Infect. Dis., 198, 6:171–176.
58. Schneider, M., C. W. Vildozola, and S. Brooks. Quantitative assessment of bacterial invasion of chronic ulcers. Statistical analysis. Am. J. Surg., 1983, 145:260–262.
59. Schraibman, I. G. The significance of beta-haemolytic streptococci in chronic leg ulcers. Ann. R. Coll. Surg. Med., 1990, 7292:123–124.
60. Summanen, P. H., D. A. Talan, C. Strong, M. McTeague, R. Bennion, J. E.
61. Thompson, Jr., M. L. Vaisanen, G. Moran, M. Winer, and S. M. Finegold. Bacteriology of skin and soft-tissue infections: com- parison of infections in intravenous drug users and individu-
als with no history of intravenous drug use. Clin. Infect. Dis.1995, 20:S279–S282.
62. Tonetti, M., C. Eftimiadi, G. Damiani, P. Buffa, D. Buffa, and G. A. Botta. Inhibition of phagocytosis in vitro by obligate anaerobes. Lancet, 1977, ii:1252–1254.
63. Torres, P. J., Fletcher, E.M., Gibbons, S.M., Bouvet, M., Doran, K. S., and Kelley, S. T. Characterization of the salivary microbiome in patients with pancreatic cancer. 2015, (3): e1373.
64. Twum-Danso, K., C. Grant, S. A. Al-Suleiman, S. Abdel-Khaders, M. S. Al-Awami, H. Al-Breiki, S. Taha, A.-A. Ashoor, and L. Wosornu. Microbiology of postoperative wound infection:
a prospective study of 1770 wounds. J. Hosp. Infect., 1992,21:29–37.
65. Vindenes, H., and R. Bjerknes. Microbial colonisation of large wounds. Burns, 1995, 21:575–579.
66. Wright, A. E., A. Fleming, and L. Colebrook. The conditions under which the sterilisation of wounds by physiological agency can be obtained. Lancet, 1918, i:831–838.
Keywords:
colonization, soft tissue infections, microbial load, quantitative microbiology, qualitative microbiology
How to cite this article:
I. Gergova, T. Badarov. Assessement of the diagnostic value of different techniques for sampling of specimens for microbiological examination in soft tissue infections. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2025; 13(1): 25-33
Corresponding author:
Assoc. Prof. Ivanka Gergova, MD, PhD
Military Medical Academy -Sofia, Department of Microbiology, Virology, Clinical laboratory and
Immunology,
3 Georgi Sofijsky Str., Sofia 1606
e-mail: gergova.ivana7@gmail.com