Addressing the challenges of remote diagnostics: diagnostic yield of point-of-care nucleic acid amplification tests (NAAT) versus conventional culture for the detection of skin ulcer pathogens

Abstract Identification of pathogenic bacteria in skin ulcers typically relies on conventional culture; however, culture outcome can be compromised by extended transport times to centralised laboratories. Point-of-care Nucleic Acid Amplification Tests (NAAT) offer a rapid alternative in these settings. This study compared the diagnostic yield of point-of-care NAAT versus conventional culture for the detection of Staphylococcus aureus and Streptococcus pyogenes . A prospective, cross-sectional study was conducted at a remote emergency department (n = 768). Triple swabs were collected from patients presenting with skin ulcers (n = 106). Detection rates were compared between centralised conventional culture (subject to transport delays) and on-site NAAT (isothermal and thermal cycling). S. aureus was the most prevalent pathogen (23% via culture vs. 44% via NAAT). Overall, NAAT identified target pathogens approximately twice as frequently as culture. These differences were statistically significant for S. aureus ( p < 0.001). NAAT provides significantly higher yield than conventional culture in this remote setting where long transport times may compromise bacterial viability.