Abstract
Acute bacterial skin and skin structure infections (ABSSSI) is a common cause of acute admissions worldwide, but the disease is not well understood epidemiologically with respect to factors that determine positive blood cultures or patient mortality. To understand the utility of blood cultures and the association between bacteremia and mortality in patients with ABSSSI, we conducted a retrospective study to investigate factors associated with positive blood cultures and mortality in patients with ABSSSI. A retrospective cohort study of hospitalized adult patients with ABSSSI was conducted in a tertiary hospital in Taiwan between March 2015 and December 2016. A total of 1322 hospitalized patients with ABSSSI are included. The overall mortality rate is 2.1% (28/1322), and 122 patients had positive blood culture results. Comorbidities that are significant risk factors for a positive blood culture include diabetes mellitus and chronic kidney disease. Significant risk factors evident in laboratory evaluations include high C-reactive protein (CRP) level (> 20 mg/dL), hyperglycemia, and hypoalbuminemia. Bacteremia is also a significant factor associated with mortality. A blood culture should be considered for patients with ABSSSI with diabetes mellitus or chronic kidney disease or those exhibiting abnormal CRP, glucose, or albumin levels because of the positive correlation between bacteremia and mortality.
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References
Guidance for industry acute bacterial skin and skin structure infections: developing drugs for treatment. U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER) October 2013. http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/default.htm
Bisno AL, Stevens DL (1996) Streptococcal infections of skin and soft tissues. N Engl J Med 334:240–245
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al (2014) Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 59:e10–e52
Perl B, Gottehrer NP, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM (1999) Costeffectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis 29:1483–1488
Swartz MN (2004) Clinical practice. Cellulitis. N Engl J Med. 350:904–912
Peralta G, Padrón E, Roiz MP, De Benito I, Garrido JC, Talledo F et al (2006) Risk factors for bacteremia in patients with limb cellulitis. Eur J Clin Microbiol Infect Dis 25:619–626
Gunderson CG, Martinello RA (2012) A systematic review of bacteremias in cellulitis and erysipelas. J Infect 64:148–155
Paolo WF, Poreda AR, Grant W, Scordino D, Wojcik S (2013) Blood culture results do not affect treatment in complicated cellulitis. J Emerg Med 45:163–167
Lee CY, Kunin CM, Chang C et al (2016) Development of a prediction model for bacteremia in hospitalized adults with cellulitis to aid in the efficient use of blood cultures: a retrospective cohort study. BMC Infect Dis 16:581
Perl B, Gottehrer NP, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM (1999) Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis. 29(6):1483–1488
Kielhofner MA, Brown B, Dall L (1998) Influence of underlying disease process on the utility of cellulitis needle aspirates. Arch Intern Med 148(11):2451–2452
Figtree M, Konecny P, Jennings Z, Goh C, Krilis SA, Miyakis S (2010) Risk stratification and outcome of cellulitis admitted to hospital. J Infect 60(6):431–439
Blackberg A, Trell K, Rasmussen M (2015) Erysipelas, a large retrospective study of aetiology and clinical presentation. BMC Infect Dis 15:402
Semel JD, Goldin H (1996) Association of athlete’s foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples. Clin Infect Dis 23:1162–1164
Bruun T, Oppegaard O, Kittang BR, Mylvaganam H, Langeland N, Skrede S (2016) Etiology of cellulitis and clinical prediction of streptococcal disease: a prospective study. Open Forum Infect Dis. 3:181
Baibergenova A, Drucker AM, Shear NH (2014) Hospitalizations for cellulitis in Canada: a database study. J Cutan Med Surg. 18:33–37
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The authors thank all the participants who participated in this study. This manuscript was edited by Wallace Academic Editing.
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The institutional review board of our hospital approved this retrospective study (100-4178B).
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Chang, CP., Hsiao, CT. & Fann, WC. Risk factors associated with bacteremia correlated with mortality in patients with acute bacterial skin and skin structure infection. Intern Emerg Med 14, 259–264 (2019). https://doi.org/10.1007/s11739-018-1973-0
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DOI: https://doi.org/10.1007/s11739-018-1973-0