, Volume 40, Issue 5, pp 537–541

PCR offers no advantage over culture for microbiologic diagnosis in cellulitis

  • K. E. Johnson
  • D. E. Kiyatkin
  • A. T. An
  • S. Riedel
  • J. Melendez
  • J. M. Zenilman
Clinical and Epidemiological Study



Most cases of cellulitis are traditionally attributed to β-hemolytic Streptococcus and Staphylococcus species, although in most cases, no organism is identified. Development of PCR using the conserved bacterial 16 S rRNA DNA permits identification of bacteria independent of conventional culture approaches and prior use of antibiotics.


We used PCR-based techniques to identify cellulitis etiology using aspirate samples from affected skin. Saline was infiltrated and aspirated at the site of greatest erythema or at the cellulitic border. Samples were tested for 16 S rRNA DNA, and organism-specific probes used to identify bacteria commonly seen in skin infections.


Aspirates from 32 patients were studied, and 16 S rRNA DNA was detected in nine of these patient samples (28.1 %). Bacterial species were identified by PCR methods in six of these nine samples (66.6 %), with S. aureus and methicillin-resistant S. aureus (MRSA) identified in four and two, respectively, of these samples. Of the patients with positive aspirate bacterial cultures (3/9, 33.3 %), S. aureus and coagulase-negative Staphylococcus (CoNS) were present on cultures of two of the three (both 66.6 %) positive samples. Only in one of the three positive bacterial cultures did the PCR method detect the same organism as was detected by culture. Among patients with positive provider-collected clinical cultures, MRSA was the predominant organism (11/18, 61.1 %) and when present, it was found as the sole organism. Where S. aureus or Streptococcus species were detected by molecular methods, clinical cultures yielded a positive result as well.


PCR-based techniques do not appear to be more sensitive than aspirate cultures for the detection of pathogens in cellulitis.


Cellulitis Eukaryotic PCR 16S rRNA Skin and skin structure infection  Skin and soft tissue infection 


  1. 1.
    Howe PM, Eduardo FJ, Orcutt MA. Etiologic diagnosis of cellulitis: comparison of aspirates obtained from the leading edge and the point of maximal inflammation. Pediatr Infect Dis J. 1987;6:685–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Hook EW III, Hooton TM, Horton CA, Coyle MB, Ramsey PG, Turck M. Microbiologic evaluation of cutaneous cellulitis in adults. Arch Intern Med. 1986;146:295–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Kennedy LA, Gill JA, Schultz ME, Irmler M, Gordin FM. Inside-out: the changing epidemiology of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2010;31:983–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Deleo FR, Otto M, Kreiswirth BN, Chambers HF. Community-associated methicillin-resistant Staphylococcus aureus. Lancet. 2010;375:1557–68.PubMedCrossRefGoogle Scholar
  5. 5.
    Hersh AL, Chambers HF, Maselli JH, Gonzales R. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med. 2008;168:1585–91.PubMedCrossRefGoogle Scholar
  6. 6.
    Wells RD, Mason P, Roarty J, Dooley M. Comparison of initial antibiotic choice and treatment of cellulitis in the pre- and post-community-acquired methicillin-resistant Staphylococcus aureus eras. Am J Emerg Med. 2009;27:436–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Jeng A, Beheshti M, Li J, Nathan R. The role of beta-hemolytic streptococci in causing diffuse, nonculturable cellulitis: a prospective investigation. Medicine (Baltimore). 2010;89:217–26.CrossRefGoogle Scholar
  8. 8.
    Epperly TD. The value of needle aspiration in the management of cellulitis. J Fam Pract. 1986;23:337–40.PubMedGoogle Scholar
  9. 9.
    Liles DK, Dall LH. Needle aspiration for diagnosis of cellulitis. Cutis. 1985;36:63–4.PubMedGoogle Scholar
  10. 10.
    Chira S, Miller LG. Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review. Epidemiol Infect. 2010;138:313–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Linscott A.J. Specimen collection, transport and acceptability. In: Garcia LS (ed) Clinical microbiology procedures handbook, 3rd edn. American Society for Microbiology (ASM) Press, Herndon, pp 2.1.1–2.1.6, 2010.Google Scholar
  12. 12.
    Sharp SE, Bowler PG, Church DL. Wound cultures. In: Garcia LS (ed) Clinical microbiology procedures handbook, 3rd edn. American Society for Microbiology (ASM) Press, Herndon, pp 3.13, 2010.Google Scholar
  13. 13.
    Melendez JH, Frankel YM, An AT, et al. Real-time PCR assays compared to culture-based approaches for identification of aerobic bacteria in chronic wounds. Clin Microbiol Infect. 2010;16:1762–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Goldgeier MH. The microbial evaluation of acute cellulitis. Cutis. 1983;31(649–4):656.Google Scholar
  15. 15.
    Patel Wylie F, Kaplan SL, Mason EO, Allen CH. Needle aspiration for the etiologic diagnosis of children with cellulitis in the era of community-acquired methicillin-resistant Staphylococcus aureus. Clin Pediatr (Phila). 2011;50(6):503–7.Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • K. E. Johnson
    • 1
  • D. E. Kiyatkin
    • 2
  • A. T. An
    • 1
  • S. Riedel
    • 3
  • J. Melendez
    • 1
  • J. M. Zenilman
    • 1
  1. 1.Division of Infectious Diseases, Department of Medicine, The Johns Hopkins Medical InstitutionsJohns Hopkins Bayview Medical CenterBaltimoreUSA
  2. 2.Division of Hospital Medicine, Department of Medicine, The Johns Hopkins Medical InstitutionsJohns Hopkins Bayview Medical CenterBaltimoreUSA
  3. 3.Division of Microbiology, Department of Pathology, The Johns Hopkins Medical InstitutionsJohns Hopkins Bayview Medical CenterBaltimoreUSA

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