Advertisement

Low yield of blood and wound cultures in patients with skin and soft-tissue infections

      Abstract

      Background

      Current guidelines recommend blood cultures in skin and soft-tissue infection (SSTI) patients only with signs of systemic toxicity and wound cultures for severe purulent infections. Our objectives were to determine: 1) blood and wound culture yields in patients admitted with SSTIs; 2) whether injection drug users (IDUs) and febrile patients had higher blood culture yields; and 3) whether blood and wound cultures grew organisms sensitive to typical SSTI empiric antibiotics.

      Methods

      We prospectively enrolled adult patients admitted from the ED with SSTIs at an urban hospital. We recorded patient characteristics, including IDU, comorbidities and temperatures, and followed admitted patients throughout their hospital course.

      Results

      Of 734 SSTI patients enrolled, 246 (33.5%) were admitted. Of 86 (35.0%) patients who had blood cultures, six had positive cultures (yield = 7.0%; 95% confidence intervals [CIs] 3.2–14.4); 4 were methicillin sensitive Staphylococcus aureus (MSSA) and 2 were methicillin resistant (MRSA). Of 29 febrile patients, 1 had a positive culture (yield = 3.5%; 95% CI 0.6–17.2). Of 101 admitted IDU patients, 46 (46%) received blood cultures, and 4 had positive cultures (yield = 8.7%; 95% CI 3.4–20.3).
      Of 89 patients with purulent wounds, 44 (49.4%) patients had ED wound cultures. Thirteen had positive cultures (yield = 29.6%; 95% CI 18.2–44.2%). Most were MRSA, MSSA, and group A Streptococcus species — all sensitive to Vancomycin.

      Conclusions

      Febrile and IDU patients had low yields of blood cultures similar to yields in non-IDU and afebrile patients. All blood and wound culture species were adequately covered by currently recommended empiric antibiotic regimens.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Pallin D.J.
        • Egan D.J.
        • Pelletier A.J.
        • Espinola J.A.
        • Hooper D.C.
        • Camargo C.A.
        Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin resistant Staphylococcus aureus.
        Ann Emerg Med. 2008; 51: 291-298
        • Hersh A.L.
        • Chambers H.F.
        • Maselli J.H.
        • Gonzales R.
        National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections.
        Arch Intern Med. 2008; 168: 1585-1591
        • Edelsberg J.
        • Taneja C.
        • Zervos M.
        • Haque N.
        • Moore C.
        • Reyes K.
        • et al.
        Trends in US hospital admissions for skin and soft tissue infections.
        Emerg Infect Dis. 2009; 15: 1516-1518
        • Moran G.J.
        • Krishnadasan A.
        • Gorwitz R.J.
        • Fosheim G.E.
        • McDougal L.K.
        • Carey R.B.
        • et al.
        Methicillin-resistant S. aureus infections among patients in the emergency department.
        New Engl J Med. 2006; 355: 666-674
        • Perl B.
        • Gottehrer N.P.
        • Raveh D.
        • et al.
        Cost-effectiveness of blood cultures for adult patients with cellulitis.
        Clin Infect Dis. 1999; 29: 1483-1488
        • Kulthanan K.
        • Rongrungruang Y.
        • Siriporn A.
        • et al.
        Clinical and microbiologic findings in cellulitis in Thai patients.
        J Med Assoc Thail. 1999; 82: 587-592
        • Lutomski D.M.
        • Trott A.T.
        • Runyon J.M.
        • et al.
        Microbiology of adult cellulitis.
        J Fam Pract. 1988; 26: 45-48
        • Hook 3rd, E.W.
        • Hooton T.M.
        • Horton C.A.
        • et al.
        Microbiologic evaluation of cutaneous cellulitis in adults.
        Arch Intern Med. 1986; 146: 295-297
        • Ho P.W.
        • Pien F.D.
        • Hamburg D.
        Value of cultures in patients with acute cellulitis.
        South Med J. 1979; 72: 1402-1403
        • Abrahamian F.M.
        • Shroff S.D.
        Use of routine wound cultures to evaluate cutaneous abscesses for community-associated methicillin-resistant Staphylococcus aureus.
        Ann Emerg Med. 2007; 50: 66-67
        • Stevens D.L.
        • Bisno A.L.
        • et al.
        Practice guidelines for the diagnosis and management of skin and soft-tissue infections.
        Clin Infect Dis. 2005; 41: 1373-1406
        • Gilbert E.H.
        • Lowenstein S.R.
        • Koziol-McLain J.
        Chart reviews in emergency medicine research: where are the methods?.
        Ann Emerg Med. 1996; 27: 305-308
        • Mcmurray B.R.
        • Wrenn K.D.
        • Wright S.W.
        Usefulness of blood cultures in pyelonephritis.
        Am J Emerg Med. 1997; 15: 137-140
        • Chen Y.
        • Nitzan O.
        • Saliba W.
        • Chazan B.
        • Colodner R.
        • Raz R.
        Are blood cultures necessary in the management of women with complicated pyelonephritis?.
        J Infect. 2006; 53: 235-240
        • Jones M.E.
        • Karlowsky J.A.
        • Draghi D.C.
        • Thornsberry C.
        • Sahm D.F.
        • Nathwani D.
        Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial therapy.
        Int J Antimicrob Agents. 2003; 22: 406-419
        • Coburn B.
        • Morris A.M.
        • Tomlinson G.
        • Detsky A.S.
        Does this adult patient with suspected bacteremia require blood cultures?.
        JAMA. 2012; 308: 502-511
        • Hook 3rd, E.W.
        • Hooton T.M.
        • Horton C.A.
        • et al.
        Microbiologic evaluation of cutaneous cellulitis in adults.
        Arch Intern Med. 1986; 146: 295-297