Wound Cultures

I like to know what I am dealing with especially when it seems to be something simple. The doctor I worked with in family practice used to joke about the average weight of my patients. This was because the average weight would easily have been over 350 pounds. It’s just a fact that fat people have more health problems. I didn’t make the rules that’s just the way it works.

One after noon a diabetic patient presented with a small sore on her arm that just would not heal. I was just out of school but that didn’t mean that I was completely clueless about treatments. I ran into the other Nurse Practitioner in the hallway and for some reason she decided she was going to tell me how to treat this patient. Just put some bacitracin ointment on it, she said.

I listened, nodded my head, smiled, and went on my way. I rummaged around in the drawer in the stock room and pulled a culture kit out. Getting a wound culture is cheap and easy, and can save you a lot of time when treating patients. Sure I could have put some ointment on her arm and sent her away, but she had been using polysporin for over 6 weeks without the small sore getting better. I always treat diabetics aggressively and I was going to treat her the same way.

A wound culture is obtained by running a sterile cotton swab (sometimes Dacron) in the wound and sending it to the lab. The lab infects petri dishes using the contaminated  swab. The dish usually contains some type of material that bacteria can use for food. The dishes are placed in a warm environment and are watched for three days. After three days they are examined to see what kind of bacteria grew in the dish. The dishes are treated in different spots with drops of antibiotics to see which antibiotics will kill the bacteria. The antibiotics are added prior to rubbing the contaminated cotton swab across the pitre dish. This is called a C & S, or culture and sensitivity.

The culture part tells us what is growing, the sensitivity part tells us which antibiotic will kill the bacteria. C&S can be done on wounds, urine, stool, hocked up phlegm etc… They tell the provider what the patient is infected with and what antibiotic (if its bacterial not viral) can be used to kill it.

This ladies arm wound turned out to be infected with methicillin resistant staphylococcus aureus (MRSA). A nasty bug found primarily in hospitals and on the fingers of health care workers, especially ones who don’t wash their hands. This woman had been in the hospital and had first developed this sore there. Probably from a health care worker who did not wash his/her hands. Never be afraid to tell a health care worker to wash their hands in the sink in front of you before letting them touch you. It might make some people upset but maybe they didn’t wash their hands at the nurses station. Its your life and health. Some of these bugs can and do kill patients with compromised immune systems.

For this patient I had to change the antibiotic I had started her on to a stronger one. She healed quickly after the appropriate treatment.

This past week I inherited a 339 pound diabetic with renal failure, sleep apena, post coronary artery bypass graft (CABG, pronounced cabbage), with hypertension, high cholesterol, and a tracheostomy. She also had what looked like a large scratch on the inside of her left knee. One of the nurses asked me if he could culture it. Sure I responded, who knows what funky stuff would grow out of this wound.

Today I received a call that the culture results were back and vancomycin resistant enterococcus (VRE) was the offending organism. Actually the culprit was probably a health care worker who did not wash their hands. This is a nasty bug which is almost 100% contracted from health care institutions or health care workers.

I ordered the appropriate treatment for my patient, of course it’s very expensive, and I hope she gets better before the bug gets a foothold and she crashes.

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