The Optimum Use of Needle Aspiration in the Bacteriologic Diagnosis of Cellulitis in Adults

Sachs, Mark K.

doi:10.1001/archinte.1990.00390200091017

Cited by 60 publications

(15 citation statements)

References 27 publications

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“…The microorganism was recovered more frequently among patients with abscess (15% vs 8%) or cSSTI (56% vs 25%) than in patients with uncomplicated cellutitis (29% vs 67%, p = 0.001). Patients with positive microbiology results had longer duration of treatment (median [IQR]: 18 [15-29.5] vs 15 [12][13][14][15][16][17][18][19] days, p = 0.003) and longer hospital stay (11 [7][8][9][10][11][12][13][14][15][16][17] vs 8 [5][6][7][8][9][10][11][12][13] days, p = 0.014).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, treatment guidelines establish their recommendations either on the basis of the isolated microorganism 5 or according to a clinical classification 6 . However, most patients receive empirical treatment, since the causative etiological agent is isolated in less than 20% of aspirates 7,8 , and only 2% of blood cultures are positive 9 . Only in the more serious infections, such as necrotising fasciitis, the proportion of positive blood cultures is significantly greater; rising to 80% 10 .…”

Section: Introductionmentioning

confidence: 99%

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Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Pérez-Rodríguez¹,

Argibay²,

Nodar³

et al. 2014

Gal. Clin.

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ResumenObjetivos: Existen diferentes guías de tratamiento de la infección de piel y partes blandas (IPPB), sin embargo el tratamiento de estos pacientes es muy variable. Los objetivos fueron analizar las pautas antibióticas, así como su duración en pacientes con IPPB que precisaron ingreso. Pacientes y métodos: Se revisaron los pacientes con IPPB ingresados entre enero y diciembre de 2009. Se recogieron las pautas de tratamiento antibiótico empleadas antes, durante y tras el ingreso, así como su duración. Resultados: De un total de 131 pacientes con IPPB ingresados, se identificaron 41 pautas diferentes de tratamiento antibiótico. En 61 pacientes (47%) se emplearon dos o más fármacos y en 21 (16%) antibióticos de amplio espectro. En 25 pacientes (19%) se modificó la pauta antibiótica por mala evolución y se utilizaron 16 regímenes antibióticos diferentes. En los pacientes con fracaso del tratamiento antibiótico, ni la duración del ingreso (12 ± 9.0 días vs. 14 ± 8.7 días, p = 0.31), ni la duración del tratamiento antibiótico (12 ± 8.2 días vs. 14 ± 6.8 días, p = 0.33) fueron superiores a la de aquellos en los que la respuesta al tratamiento empírico inicial fue adecuada. Al alta, 95 pacientes (73%) recibieron tratamiento antibiótico, se identificaron 25 regímenes diferentes; 22 pacientes (23%) recibieron dos o más antibióticos y antibióticos de amplio espectro se pautaron en 10 casos. Conclusiones: La IPPB es una causa creciente de hospitalización y, a pesar de existir guías recientes de tratamiento, las pautas de tratamiento antibiótico son altamente variables. Palabras clave: Celulitis; infección de piel y partes blandas; absceso cutáneo; tratamiento antibiótico. AbstractObjetives: There are several clinical guidelines for the management of skin and soft tissue infections (SSTI); however, the empirical treatment of patients with this common cause of hospital admission is highly variable. The aims of this study were to determine the empirical antibiotic treatment regimes and the duration of antibiotic treatment of SSTI requiring hospitalization. Patients and methods: Cases admitted for SSTI were reviewed. We evaluated antibiotic therapy before, during and after hospitalization, as well as duration of treatment. Results: From the 131 patients, 41 different antibiotic regimes were identified. Antibiotic combinations were used in 61 patients (47%) and broadspectrum antibiotics were used in 21 patients (16%). Modification of the antibiotic regimen was required in 25 patients (19%) due to poor clinical response, and 16 different regimes were prescribed. For patients with treatment failure, neither duration of hospitalization (12 ± 9.0 days vs. 14 ± 8.7 days, p = 0.31) nor duration of antibiotic treatment (12 ± 8.2 days vs. 14 ± 6.8 days, p = 0.33) were greater than for those who responded to the initial empirical treatment. On discharge, antibiotic treatment was prescribed for 95 patients (73%), with 25 different regimes, including a combination of drugs in 22 patients (23%) and broad-spectrum antibiotics in 10. Con...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Pérez-Rodríguez¹,

Argibay²,

Nodar³

et al. 2014

Gal. Clin.

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“…Most assessment schemes attempt to differentiate necrotizing from non-necrotizing infections because of the urgent need for surgical intervention in the former [6]. Bacteremia complicating cellulitis has been described previously but has not been shown to be associated with a greater risk of morbidity and death [2][3][4]. Bacteremia complicating cellulitis caused by non-group A streptococci superimposed on lymphedema occurs in 30% of patients [7].…”

Section: Discussionmentioning

confidence: 99%

“…Bacteremia complicating soft-tissue infections has been described infrequently [2][3][4], and the influence of secondary bacteremia on the outcomes of patients with soft-tissue infections is not well described [1]. Soft-tissue infections complicated by bacteremia may represent a subgroup of infections requiring more aggressive antimicrobial therapy because of differences in causative pathogens, severity of illness, and outcomes.…”

mentioning

confidence: 99%

Bacteremia Increases the Risk of Death among Patients with Soft-Tissue Infections

Micek

Hoban

Pham

et al. 2010

Surgical Infections

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increases the risk of death among patients with soft-tissue infections." Surgical infections.11,2. 169-176. (2010 , and bacteremia (AOR 6.37; 95% CI 3.34, 12.12) were independent predictors of in-hospital death. When patients with device-related soft-tissue infections were excluded, the rate of secondary bacteremia was 37.6% (201=535), and it remained an independent predictor of in-hospital death. Conclusions:The occurrence of bacteremia in soft-tissue infections is associated with a greater risk of death. Health care providers should be aware of the risk factors for bacteremia in patients with soft-tissue infections in order to provide more appropriate initial antimicrobial therapy and to ascertain its presence as a prognostic indicator.

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“…Needle aspiration of the lesions of erysipelas facilitates isolating an organism in ! 30% of cases [6][7][8][9] . The yield of blood cultures appears even lower (2%) and does not appear to be cost-effective for most patients with cellulitis [10] .…”

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confidence: 99%

Involvement of <i>Staphylococcus aureus</i> in Erysipelas

Denis¹,

Simonart

2006

Dermatology

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The Optimum Use of Needle Aspiration in the Bacteriologic Diagnosis of Cellulitis in Adults

Cited by 60 publications

References 27 publications

Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Tratamiento empírico de pacientes ingresados con infección de piel y partes blandas: ¿cómo lo estamos haciendo?

Bacteremia Increases the Risk of Death among Patients with Soft-Tissue Infections

Involvement of <i>Staphylococcus aureus</i> in Erysipelas

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