Skip to main content

Advertisement

Log in

Risk factors associated with bacteremia correlated with mortality in patients with acute bacterial skin and skin structure infection

  • IM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. 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

  2. Bisno AL, Stevens DL (1996) Streptococcal infections of skin and soft tissues. N Engl J Med 334:240–245

    Article  PubMed  CAS  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. Swartz MN (2004) Clinical practice. Cellulitis. N Engl J Med. 350:904–912

    Article  PubMed  CAS  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. Gunderson CG, Martinello RA (2012) A systematic review of bacteremias in cellulitis and erysipelas. J Infect 64:148–155

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. 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

    Article  Google Scholar 

  12. 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

    Article  PubMed  CAS  Google Scholar 

  13. Blackberg A, Trell K, Rasmussen M (2015) Erysipelas, a large retrospective study of aetiology and clinical presentation. BMC Infect Dis 15:402

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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

    Article  PubMed  CAS  Google Scholar 

  15. 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

    Article  CAS  Google Scholar 

  16. Baibergenova A, Drucker AM, Shear NH (2014) Hospitalizations for cellulitis in Canada: a database study. J Cutan Med Surg. 18:33–37

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank all the participants who participated in this study. This manuscript was edited by Wallace Academic Editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wen-Chih Fann.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Statement of human and animal rights

The institutional review board of our hospital approved this retrospective study (100-4178B).

Informed consent

Consent to participate was not applicable.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-018-1973-0

Keywords

Navigation