Impact of health care–associated community-onset cellulitis in Korea: a multicenter study

  • Seong Yeon Park
  • Tark Kim
  • Seong-Ho Choi
  • Jiwon Jung
  • Shi Nae Yu
  • Hyo-Lim Hong
  • Yong Kyun Kim
  • Se Yoon Park
  • Eun Hee Song
  • Ki-Ho Park
  • Oh-Hyun Cho
  • Sang Ho Choi
  • Yee Gyung KwakEmail author
  • and the Korean SSTI (Skin and Soft Tissue Infection) Study Group
Original Article


We conducted a multicenter study to determine the clinical and microbiological characteristics of health care–associated (HCA) cellulitis in Korea. We retrospectively reviewed the medical records of patients who had been diagnosed with community-onset cellulitis. Of the 2208 cellulitis patients, 232 (10.5%) had HCA cellulitis, 1243 (56.3%) patients were hospitalized, and 15 (0.7%) died in hospital. Compared with community-acquired (CA) cellulitis, patients with HCA cellulitis were older and more frequently presented with comorbidity and septic shock. A total of 355 microorganisms were isolated from 314 patients (14.2%). Staphylococcus aureus (134 isolates) was the most common organism, followed by Streptococcus spp. (86 isolates) and Gram-negative fermenters (58 isolates). Methicillin-resistant S. aureus (MRSA) accounted for 29.1% (39/134) of S. aureus infections. None of the Gram-negative fermenters were resistant to carbapenem. The antibiotic susceptibility pattern of isolated microorganisms was not different between HCA and CA cellulitis. In patients with HCA cellulitis, S. aureus (11.2% [26/232] vs. 5.5% [108/1976], p = 0.001), including MRSA (4.3% [10/232] vs. 1.5% [29/1976], p = 0.003) and Gram-negative fermenters (6.0% [14/232] vs. 2.3% [44/1976], p = 0.002), were more common causative organisms than in CA-cellulitis patients. Age ≥ 65 years, septic shock, and HCA infection were statistically significant factors associated with in-hospital mortality.


Cellulitis Health care–associated infection Staphylococcus aureus 


Authors’ contributions

PSY contributed to the study design, data gathering, analyses, and interpretation and wrote the first draft of the manuscript. KT, JJ, CSH, YSN, HHL, KYK, PSY, SHE, PKH, COH, and CSH contributed to data analyses and data interpretation, and critiqued the report. KYG contributed to the study design, data interpretation, and review and critiqued the report. KYG had full access to all data and made the final decision to submit for publication.

Compliance with ethical standards

Conflict of interest

The author declare that they have no conflict of interest.

Ethical approval

This work was approved by the Institutional Review Board of each hospital, and informed consent was waived since this was a retrospective study without intervention that did not involve extra clinical specimens.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Seong Yeon Park
    • 1
  • Tark Kim
    • 2
  • Seong-Ho Choi
    • 3
  • Jiwon Jung
    • 4
    • 5
  • Shi Nae Yu
    • 6
  • Hyo-Lim Hong
    • 7
  • Yong Kyun Kim
    • 8
  • Se Yoon Park
    • 9
  • Eun Hee Song
    • 10
  • Ki-Ho Park
    • 11
  • Oh-Hyun Cho
    • 12
  • Sang Ho Choi
    • 5
  • Yee Gyung Kwak
    • 13
    Email author
  • and the Korean SSTI (Skin and Soft Tissue Infection) Study Group
  1. 1.Department of Internal MedicineDongguk University Ilsan HospitalGoyangSouth Korea
  2. 2.Department of Internal MedicineSoonchunhyang University Bucheon HospitalBucheonSouth Korea
  3. 3.Department of Internal MedicineChung-Ang University HospitalSeoulSouth Korea
  4. 4.Department of Internal MedicineUlsan University HospitalUlsanSouth Korea
  5. 5.Department of Infectious Diseases, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  6. 6.Department of Internal MedicineSoonchunhyang University Cheonan HospitalCheonanSouth Korea
  7. 7.Department of Internal MedicineDaegu Catholic University Medical CenterDaeguSouth Korea
  8. 8.Department of Internal MedicineInje University Haeundae Paik HospitalBusanSouth Korea
  9. 9.Department of Internal MedicineSoonchunhyang University Seoul HospitalSeoulSouth Korea
  10. 10.Department of Internal MedicineGangneung Asan HospitalGangneungSouth Korea
  11. 11.Department of Internal MedicineKyung Hee University Hospital, Kyung Hee University School of MedicineSeoulSouth Korea
  12. 12.Department of Internal MedicineGyeongsang National University Changwon HospitalChangwonSouth Korea
  13. 13.Department of Internal MedicineInje University Ilsan Paik HospitalGoyang-siSouth Korea

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