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Peer-reviewedCC BYInternational wound journal

The Value of Cleaning a Skin Ulcer Before Obtaining a Swab to Detect Staphylococcus aureus, MRSA and Streptococcus pyogenes.

  • Ulrich Orda1
  • Sabine Orda1
  • Ronny Gunnarsson2,3,4,5
5 affiliations
  1. 1Darling Downs Hospital and Health Service, Southern Cluster, Warwick Hospital, Warwick, Queensland, Australia.
  2. 2School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  3. 3Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
  4. 4The Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.
  5. 5The College of Medicine and Dentistry, James Cook University, Cairns, Australia.
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Abstract

Accurate identification of pathogens in clinically infected skin ulcers is essential for targeted antimicrobial therapy. Although expert consensus recommends mechanical cleansing of the ulcer bed prior to swabbing, there is a lack of empirical evidence to support this practice. This study investigated the impact of mechanical cleansing with sterile cotton gauze pads saturated with isotonic saline or clean water on microbiological results. Triple swabs were collected from 106 patients with skin ulcers at two distinct time points: prior to cleansing (baseline) and immediately following mechanical cleansing. All specimens were analysed using both conventional culture and point-of-care nucleic acid amplification tests (NAAT) for Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), and Streptococcus pyogenes. S. aureus was the most prevalent isolate, with detection rates of 23%-24% by culture and 44%-45% by NAAT. The prevalence and specific bacterial findings remained highly consistent before and after mechanical cleansing, with high levels of concordance across both diagnostic modalities. A sensitivity analysis excluding patients with recent antibiotic use confirmed these findings. Our results demonstrate that mechanical cleansing of the ulcer does not significantly alter the microbiological yield or improve the detection of key pathogens. These findings suggest that the traditional requirement for pre-sampling cleansing may be unnecessary for routine diagnostic swabbing.

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Cite

BibTeXRIS
BibTeX
@article{orda2026value,
  title = {{The Value of Cleaning a Skin Ulcer Before Obtaining a Swab to Detect Staphylococcus aureus, MRSA and Streptococcus pyogenes.}},
  author = {Ulrich Orda and Sabine Orda and Ronny Gunnarsson},
  journal = {International wound journal},
  year = {2026},
  month = oct,
  doi = {10.1111/iwj.71067},
  url = {https://europepmc.org/article/MED/42908269},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - The Value of Cleaning a Skin Ulcer Before Obtaining a Swab to Detect Staphylococcus aureus, MRSA and Streptococcus pyogenes.
AU  - Ulrich Orda
AU  - Sabine Orda
AU  - Ronny Gunnarsson
PY  - 2026
DA  - 2026/10/01
JO  - International wound journal
DO  - 10.1111/iwj.71067
UR  - https://europepmc.org/article/MED/42908269
AB  - Accurate identification of pathogens in clinically infected skin ulcers is essential for targeted antimicrobial therapy. Although expert consensus recommends mechanical cleansing of the ulcer bed prior to swabbing, there is a lack of empirical evidence to support this practice. This study investigated the impact of mechanical cleansing with sterile cotton gauze pads saturated with isotonic saline or clean water on microbiological results. Triple swabs were collected from 106 patients with skin ulcers at two distinct time points: prior to cleansing (baseline) and immediately following mechanical cleansing. All specimens were analysed using both conventional culture and point-of-care nucleic acid amplification tests (NAAT) for Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), and Streptococcus pyogenes. S. aureus was the most prevalent isolate, with detection rates of 23%-24% by culture and 44%-45% by NAAT. The prevalence and specific bacterial findings remained highly consistent before and after mechanical cleansing, with high levels of concordance across both diagnostic modalities. A sensitivity analysis excluding patients with recent antibiotic use confirmed these findings. Our results demonstrate that mechanical cleansing of the ulcer does not significantly alter the microbiological yield or improve the detection of key pathogens. These findings suggest that the traditional requirement for pre-sampling cleansing may be unnecessary for routine diagnostic swabbing.
SN  - 1742-4801
SN  - 1742-481X
ER  -