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Do Blood Cultures Change Management of Cellulitis?

Do Blood Cultures Change Management of Cellulitis?. Chirag Patel. Evidence. Two retrospective studies Adults: Perl B, Gottehrer NP, et al. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clinical Infectious Diseases 1999; 29: 1483-8.

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Do Blood Cultures Change Management of Cellulitis?

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  1. Do Blood Cultures Change Management of Cellulitis? Chirag Patel

  2. Evidence • Two retrospective studies • Adults: Perl B, Gottehrer NP, et al. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clinical Infectious Diseases 1999; 29: 1483-8. • Pediatrics: Sadow KB, Chamberlain JM. Blood Cultures in the evaluation of children with cellulitis. Pediatrics 1998; 101(3):1-4. • One prospective study • Hook EW III, Horton TM, et al. Microbiologic evaluation of cutaneous cellulitis in adults. Archives of Internal Medicine 1986;146:295-7.

  3. Cost-effectiveness of blood cultures for adult patients with cellulitis • Retrospective study of 757 consecutive adult patients diagnosed with community-acquired cellulitis. • Average of 1.3 blood cultures per pt for 553 (73%) patients • 2.0% (11) cultures were positive for non-contaminants • 9 strep or staph • 1 vibrio vulnificus (fish bone puncture) • 1 morganella morganii • 3.6% (20) cultures had contaminants • Limitation: Some patients may have received antibiotics before culture and 27% of the patients admitted didn’t have blood cultures obtained • Blood cultures did not alter treatment Perl et al. Clin Inf Dis 1999; 29:1483-8

  4. Microbiologic Evaluation of Cutaneous Cellulitis in Adults • Prospective study to evaluate the diagnostic value of cultures from primary sites of infection, aspirates from the advancing edge of erythema, skin biopsy specimens, and blood in 50 adults with cellulitis • Those treated with antibiotics prior to culture were excluded • Blood cultures positive in 2 patients (Group A streptococci and S aureus) • Authors noted that blood cultures are of little value in determining the microbial origin of acute cellulitis in a normal host Hook et al. Arch Int Med 1986; 146:295-7

  5. Children with Cellulitis • Retrospective case series of admitted patients of age 2 days to 22 years. • 381 patients identified out of which 266 had aerobic/anaerobic cultures and 243 were enrolled • 5 (2.1% [CI 0.67-4.74]) patients had positive cultures • 13 patients had contaminants in the cultures • Limitations: retrospective, 22% pts were pretreated with antibiotics, and 30% of pts admitted had no cultures (but not in the study) • No change in management noted for patients with a positive culture and uncomplicated cellulitis • 2 patients (both younger than 6 months) had underlying soft tissue or bone infections not diagnosed by culture. Antibiotics were changed using culture results. Sadow et al. Pediatrics 1998; 101(3):1-4

  6. Conclusion • Blood cultures are of little value in assessing the microbial origin of acute cellulitis in a normal host • Blood cultures should be obtained when the history or physical exam suggests deep or a complicated infection

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