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Topic · Wound

Wound molecular reporting

Wound specimens are polymicrobial, full of skin flora, and coded under some of the least forgiving ICD-10 families there are. The report has to handle all three.

One column per organism

A wound specimen often carries several organisms. CORE-ABR grades each in its own column, so a drug can read three different answers across one row — active for one organism, inactive for the next.

Colonizer or cause

Skin organisms such as Staphylococcus epidermidis and Cutibacterium acnes are frequently present without causing infection. The pathogen summary says so, and the load and cycles above LOD give the prescriber the quantity to weigh it.

Wound coding

Pressure ulcer codes (L89) need site and stage. Non-pressure chronic ulcer codes (L97) need site and severity. Abscess, cellulitis and post-procedural codes need laterality and, in several families, a seventh character. CORE-ABR checks the submitted diagnosis against the indication while the report is built and prints the coding rationale on the report.

Organisms commonly on wound panels

See the pathogens below, and the resistance genes most often relevant in skin and soft tissue: mecA / mecC, ermB / ermC and tetB / tetM.

Molecular detection does not replace culture or phenotypic susceptibility testing. The treating clinician decides.

Pathogens on Wound panels

Acinetobacter baumanniiA non-fermenting gram-negative bacillus, notorious in healthcare settings for accumulating resistance.Gram-negative bacteria · UTI · Wound · STICitrobacter freundiiAn Enterobacterales species that carries a chromosomal AmpC beta-lactamase.Gram-negative bacteria · UTI · Wound · STIEnterobacter aerogenes / cloacaeEnterobacterales with chromosomal AmpC. E. aerogenes has been renamed Klebsiella aerogenes; many panels still report the…Gram-negative bacteria · UTI · Wound · STIEscherichia coliThe most common cause of urinary tract infection, and a frequent organism in wound and intra-abdominal specimens.Gram-negative bacteria · UTI · WoundHaemophilus influenzaeA small gram-negative coccobacillus, more familiar from the respiratory tract but detected on some wound and urinary pan…Gram-negative bacteria · UTI · WoundKlebsiella pneumoniae / oxytocaCommon uropathogens and a leading host of ESBL and KPC carbapenemase genes.Gram-negative bacteria · UTI · Wound · STIProteus mirabilis / vulgarisUrease-producing Enterobacterales associated with complicated UTI, catheters and stones.Gram-negative bacteria · UTI · WoundPseudomonas aeruginosaA non-fermenting gram-negative bacillus common in chronic wounds and complicated UTI, with a long list of intrinsic resi…Gram-negative bacteria · UTI · Wound · STIStaphylococcus aureusThe leading cause of skin and soft-tissue infection, and the organism most wound reports are built around.Gram-positive bacteria · UTI · Wound · STIStaphylococcus epidermidisA coagulase-negative staphylococcus that lives on normal skin. Usually a colonizer; sometimes the cause — particularly w…Gram-positive bacteria · UTI · WoundStreptococcus pyogenesGroup A streptococcus — a cause of cellulitis, erysipelas and necrotizing soft-tissue infection.Gram-positive bacteria · UTI · WoundStreptococcus agalactiaeGroup B streptococcus — found in urinary, genital and diabetic-foot specimens.Gram-positive bacteria · UTI · WoundStreptococcus pneumoniaePneumococcus — primarily a respiratory pathogen, included on some wound panels.Gram-positive bacteria · WoundEnterococcus speciesGram-positive cocci common in urinary and wound specimens. Many panels detect E. faecalis and E. faecium in one pooled w…Gram-positive bacteria · UTI · WoundCutibacterium acnesAn anaerobic gram-positive rod of normal skin. Most often a colonizer or contaminant; a genuine cause of device, shoulde…Gram-positive bacteria · WoundMycoplasma hominis / genitaliumBacteria without a cell wall, found in genitourinary and occasionally wound specimens.Atypical and cell-wall-deficient bacteria · UTI · Wound · STICandida albicansThe most common Candida species — frequently a colonizer of skin, urine and mucosa, sometimes the cause.Fungus · UTI · Wound · STICandida glabrata / tropicalisNon-albicans Candida species. C. glabrata (now Nakaseomyces glabratus) often shows reduced susceptibility to fluconazole…Fungus · UTI · Wound · STIAspergillus fumigatus / flavusEnvironmental moulds that can cause invasive wound and burn infection in susceptible patients.Fungus · WoundBlastomyces dermatitidisA dimorphic fungus endemic to parts of North America; cutaneous lesions are a classic presentation of disseminated disea…Fungus · WoundFusarium oxysporum / solaniEnvironmental moulds that can infect wounds, burns and nails, and cause disseminated disease in immunocompromised patien…Fungus · WoundHerpes simplex virus type 1A common cause of orolabial and, increasingly, genital herpes; detected in ulcerative wound specimens.Virus · Wound · STIHerpes simplex virus type 2The classic cause of recurrent genital herpes.Virus · Wound · STIVaricella-zoster virusThe cause of chickenpox and, on reactivation, shingles — a vesicular rash that can be mistaken for bacterial skin infect…Virus · WoundEnterovirusA genus of RNA viruses that includes the causes of hand, foot and mouth disease.Virus · UTI · Wound

Resistance genes relevant to Wound

mecA / mecCMethicillin resistance (MRSA, MRSE)2 organisms on panelvanA / vanBVancomycin resistance (VRE)1 organisms on paneltetB / tetMTetracycline resistance9 organisms on panelermB / ermCMLSb resistance7 organisms on paneldfrA1 / dfrA5Trimethoprim resistance6 organisms on panelsul1 / sul2Sulfonamide resistance6 organisms on panelqnrA / qnrBPlasmid-mediated quinolone resistance7 organisms on panelqnrSPlasmid-mediated quinolone resistance3 organisms on panelClass A beta-lactamase (CTX-M)Extended-spectrum beta-lactamase (ESBL) production6 organisms on panelClass A beta-lactamase (KPC / SHV)Carbapenemase (KPC) or ESBL (SHV variants) production5 organisms on panelClass C beta-lactamase (AmpC)AmpC cephalosporinase production5 organisms on panelClass D beta-lactamase (OXA)Oxacillinase production4 organisms on panelClass B metallo-beta-lactamase (IMP / VIM)Metallo-carbapenemase production5 organisms on panel

Decision support only. The treating clinician decides. Molecular genotype does not replace phenotypic susceptibility testing, culture, or public-health reporting. Absence of a detected resistance gene does not establish susceptibility. Organism targets vary by panel; CORE-ABR is configured to the assay each laboratory runs.