1148. Using the Q Score and Q234 Score to Decrease Unnecessary Pathogen Reporting in Wound Cultures
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
  • Wound Poster final edit.pdf (306.6 kB)
  • Background: Wound cultures performed on swabs collected using superficial techniques can easily be contaminated by commensal flora. While there is acceptance that only certain pathogens identified on these cultures are likely to cause true disease, potential pathogen (PP) work-up can vary between labs and even among microbiologists. Southeastern Regional Medical Center (SRMC) does not employ a standardized method for deciding which organisms to report in wound cultures. The literature provides evidence that using the Q score or Q234 score can help microbiology appropriately identify and report likely causative pathogens obtained from a wound infection. Using these methods, potential pathogens (PP) and other organisms, including normal flora, do not receive identification (ID) and antimicrobial susceptibility testing (AST). Although the two scoring systems yield different results, both have the potential to reduce the number of pathogens reported at SRMC in a standardized manner.

    Methods: A retrospective evaluation of wound cultures processed by the SRMC microbiology laboratory was conducted for inpatients during the time period of December 28, 2015 to March 31, 2016. Culture and Gram stain results were collected and Q score and Q234 score were retrospectively calculated for each culture. The number and type of pathogens receiving ID and AST was compared for Q score, Q234 score, and actual pathogens worked up by SRMC laboratory.

    Results: A total of 41 wound cultures were reviewed during the study period. These wound cultures contained 78 pathogens, other than diptheroids (n=8) and normal flora (n=10), and the SRMC laboratory performed ID and AST on 62 organisms (79.5%). The Q score suggested performing ID and AST on 48 pathogens (61.5%); Q234 score, 47 pathogens (60.3%). A total of 16 organisms (20.5%) considered noninfectious by the literature received ID and AST and 7 organisms (9.0%) considered infectious only received morphological identification (MID).

    Conclusion: Utilizing the Q score or Q234 score for determining PP in wound cultures has the potential to decrease over-reporting of noninfectious pathogens and may reduce antibiotic consumption at a community teaching hospital. In addition, education is needed on the relevant potential pathogens to report from wound swabs.

    April Dyer, PharmD, MBA, MSCR, BCPS1, Elizabeth Dodds Ashley, PharmD, MHS, FCCP, BCPS2,3 and Obiefuna Okoye, MD, MPH1, (1)Southeastern Regional Medical Center, Lumberton, NC, (2)Duke Antimicrobial Stewardship Outreach Network (DASON), Durham, NC, (3)Duke Antimicrobial Stewardship Outreach Network, Durham, NC


    A. Dyer, None

    E. Dodds Ashley, None

    O. Okoye, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.