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.
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Article Info
Publication History
Published online: May 26, 2017
Accepted:
May 26,
2017
Received:
April 1,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
