Highlights
- •Bacteremia is rare in uncomplicated cellulitis.
- •In common settings, empirical therapy covers the typical causative bacteria.
- •Blood cultures in uncomplicated cellulitis do not influence the management.
- •Unnecessary blood cultures should be avoided in the clinical practice.
Abstract
Purpose
The frequency of bacteremia and the array of microorganisms involved in cellulitis
vary greatly among studies. Although current guidelines do not recommend routine blood
culture in uncomplicated cellulitis, their implementation in clinical practice remains
challenging. We therefore aimed to assess the frequency, determinants and microbiology
of bacteremia in hospitalized patients with uncomplicated cellulitis.
Methods
We retrospectively reviewed the medical records of all adult patients admitted at
a primary-care hospital with a diagnosis of community-acquired uncomplicated cellulitis
during a 4-year period. We looked at the factors associated with blood cultures sampling
and at the incidence, determinants and microbiology of bacteremia in this population.
Results
Among the 476 patients hospitalized with a diagnosis of cellulitis, 250 (52.5%) had
blood cultures. Fever, high C-reactive protein and lymphatic insufficiency were significantly
associated with the sampling of blood cultures. Twelve (4.8%) patients had bacteremia.
Alcoholism and duration of hospitalization were associated with bacteremia in multivariate
analysis. Among the 12 patients with bacteremia, 9 had Streptococcus sp. and 3 had
Staphylococcus aureus infection.
Conclusion
In our study population with uncomplicated cellulitis, representative of unselected
population admitted at primary-care hospitals, bacteremia was uncommon and not associated
with discriminant patient characteristics, except for alcohol abuse. Episodes of bacteremia
were exclusively due to gram-positive cocci susceptible to co-amoxicilin, a common
first-line empirical therapy. In accordance with existing guidelines, we do not recommend
to collect blood for cultures in uncomplicated cellulitis. Clinicians' awareness of
guidelines and of the poor yield of blood cultures could reduce useless investigation.
Keywords
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Article info
Publication history
Published online: August 12, 2016
Accepted:
July 27,
2016
Received in revised form:
June 6,
2016
Received:
March 6,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
