Cost-Effectiveness of Blood Cultures for Adult Patients with Cellulitis

Perl, Bezalel; Gottehrer, Nathan P.; Raveh, David; Schlesinger, Yechiel; Rudensky, Bernard; Yinnon, Amos M.

doi:10.1086/313525

Cited by 203 publications

(125 citation statements)

References 19 publications

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“…Endocarditis, meningitis, and septic shock typically have high rates of blood culture positivity, while other conditions, such as soft tissue infection, have very low rates (40).…”

Section: Determinants Of Blood Culture Positivitymentioning

confidence: 99%

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

2014

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SUMMARY Bloodstream infection (BSI) is a major cause of infectious disease morbidity and mortality worldwide. While a positive blood culture is mandatory for establishment of the presence of a BSI, there are a number of determinants that must be considered for establishment of this entity. Community-onset BSIs are those that occur in outpatients or are first identified <48 h after admission to hospital, and they may be subclassified further as health care associated, when they occur in patients with significant prior health care exposure, or community associated, in other cases. The most common causes of community-onset BSI include Escherichia coli , Staphylococcus aureus , and Streptococcus pneumoniae . Antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase/metallo-β-lactamase/carbapenemase-producing Enterobacteriaceae , have emerged as important etiologies of community-onset BSI.

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“…Endocarditis, meningitis, and septic shock typically have high rates of blood culture positivity, while other conditions, such as soft tissue infection, have very low rates (40).…”

Section: Determinants Of Blood Culture Positivitymentioning

confidence: 99%

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

2014

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“…14 However, for cellulitis, aspiration of the skin is not helpful in 75% to 80% of cases, 14 less than 5% of blood culture results are positive, 19 and approximately 20% of cultures from biopsy specimens yield an organism. 20 Positive needle aspiration results can vary, depending on the patient population, inclusion criteria, and identification of organisms as pathogens or contaminants, limiting its diagnostic value.…”

Section: Article Highlightsmentioning

confidence: 99%

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

Amin

Cerceo

Deitelzweig

et al. 2014

Mayo Clinic Proceedings

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The prevalence of skin and soft tissue infections (SSTIs) has been increasing in the United States. These infections are associated with an increase in hospital admissions. Hospitalists play an increasingly important role in the management of these infections and need to use hospital resources efficiently and effectively. When available, observation units are useful for treating low-risk patients who do not require hospital admission. Imaging tools may help to exclude abscesses and necrotizing soft tissue infections; however, surgical exploration remains the principal means of diagnosing necrotizing soft tissue infections. The most common pathogens that cause SSTIs are streptococci and Staphylococcus aureus. Methicillin-resistant S aureus (MRSA) is a prevalent pathogen, and concerns are increasing regarding the unclear distinctions between community-acquired and hospital-acquired MRSA. Other less frequent pathogens that cause SSTIs include Enterococcus species, Escherichia coli, Klebsiella species, Enterobacter species, and Pseudomonas aeruginosa. Cephalexin and clindamycin are suitable options for infections caused by streptococcal species and methicillin-susceptible S aureus. The increasing resistance of S aureus and Streptococcus pyogenes to erythromycin limits its use in these infections, and better alternatives are available. Parenteral cefazolin, nafcillin, or oxacillin can be used in hospitalized patients with nonpurulent cellulitis caused by streptococci and methicillin-susceptible S aureus. When oral MRSA therapy is indicated, clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or linezolid is appropriate. Vancomycin, linezolid, daptomycin, tigecycline, telavancin, and ceftaroline fosamil are intravenous options that should be used in MRSA infections that require patient hospitalization. In the treatment of patients with SSTIs, hospitalists are at the forefront of providing proper patient care that reduces hospital costs, duration of therapy, and therapeutic failures. This review updates guidelines on the management of SSTIs with a focus on infections caused by S aureus, particularly MRSA, and outlines the role of the hospitalist in the effective management of SSTIs.

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“…the sensitivity of blood cultures for detecting an organism in uncomplicated cellulitis is extremely poor because of the small risk of bacteraemia in this condition. [17] In septic shock, however, the probability of a positive blood culture is about 65%. Although cultures are usually considered to have a high specificity, inappropriate indications or poor sampling technique may diminish this greatly.…”

Section: Laboratory Testsmentioning

confidence: 99%