Abstract
The utility of performing blood cultures in patients with a suspected skin infection is debated. We investigated the association between blood culture positivity rates and patients’ clinical condition, including acute disease severity and comorbidity. We performed a retrospective study, including patients with cellulitis and wound infection who had been enrolled in three Dutch multicenter studies between 2011 and 2015. Patients’ acute clinical condition was assessed using the Modified Early Warning Score (MEWS; severe: MEWS ≥2) and comorbidity with the Charlson Comorbidity Index (CCI; severe: CCI ≥2). A total of 334 patients with a suspected skin infection were included. Blood cultures were performed in 175 patients (52%), 28 of whom (16%) had a positive blood culture. Data on the clinical condition were collected in 275 patients. Blood cultures were performed in 76% of the patients with a severe acute condition, compared with 48% with a non-severe acute condition (OR 3.5; 95% confidence interval: 2.0–6.2; p < 0.001). Blood cultures were positive in 18% and 12% respectively (OR 1.7 (0.7–4.1); p = 0.3). Blood cultures were performed in 53% of patients with severe comorbidity, compared with 61% without severe comorbidity (OR 0.7; 0.4–1.2; p = 0.2). Blood cultures were positive in 25% and 10% respectively (OR = 3.1; 1.2–7.5; p = 0.02). The blood culture positivity rate among hospitalized patients diagnosed with skin infections was higher than the rates reported by the Infectious Diseases Society of America guidelines, particularly in patients with severe comorbidity. Therefore, the recommendations concerning blood culture performance in patients with a skin infection should be reconsidered.
Highlights
Acute bacterial skin and soft-tissue infections (SSTI) are among the most common indications for antibiotic use in hospitalized adults [1]
We found that blood cultures were taken in 52% of patients hospitalized with cellulitis or wound infections, with a positivity rate of 16%
More blood cultures were performed in patients with a severe compared with patients with a non-severe acute clinical condition, but positivity rates of blood cultures were significantly higher in patients with severe comorbidity
Summary
Acute bacterial skin and soft-tissue infections (SSTI) are among the most common indications for antibiotic use in hospitalized adults [1]. Cellulitis involves the deep dermis and subcutaneous tissues, whereas erysipelas is limited to superficial dermal structures with well-defined borders, it is presently considered a manifestation of cellulitis [2,3,4,5]. Most of these infections arise from beta-hemolytic streptococci. Staphylococcus aureus can cause cellulitis, typically in the presence of an open wound or previous penetrating trauma. Wound infections are defined by the presence of a preexisting skin lesions at the time of skin infection onset, such as a chronic ulcer or a trauma-related skin lesion, and can vary from superficial skin infection to deeper infection with involvement of tissues under the skin [6, 7]
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