Blood Cultures in the Evaluation of Uncomplicated Skin and Soft Tissue Infections

Abstract

BACKGROUND: Blood cultures are often obtained in children hospitalized with skin and soft tissue infections (SSTIs). Because little evidence exists to validate this practice, we examined the yield of blood cultures in the evaluation of immunocompetent children with SSTIs. METHODS: Medical records were reviewed for all children admitted between January 1, 2007 and December 31, 2009 after emergency department evaluation and diagnosis of cellulitis or abscess. We compared patients with SSTIs (n = 482) with those with complicated SSTIs (cSSTIs; n = 98). A cSSTI was defined as surgical or traumatic wound infection, need for surgical intervention, or infected ulcers or burns. The SSTI group included patients without complicating factors. RESULTS: None of the patients in the SSTI group had a positive blood culture. In the cSSTI group, 12.5% of blood cultures were positive. The mean length of hospital stay (LOHS) of children with SSTIs was shorter than that of those with cSSTIs (P < .001). In the SSTI group, obtaining a blood culture was associated with a higher mean LOHS (P = .044). CONCLUSIONS: Blood cultures are not useful in evaluating immunocompetent children who are admitted to the hospital with uncomplicated SSTIs, and they are associated with a nearly 1-day increase in mean LOHS.

Bacteremia in previously healthy children in Emergency Departments: clinical and microbiological characteristics and outcome

“…Indeed, some studies have shown a poor performance of this tool when used in other populations. In this way, different studies performed in adult populations have identified subgroups of patients with UTI [17] or cellulitis [18] who are more likely to have concomitant bacteremia, but this finding rarely modifies the subsequent management of patients with UTIs [19], pneumonia [20,21], or cellulitis [22,23]. Other studies have validated these findings in pediatric populations, concluding that the presence of a positive BC seldom modifies the outcome of children with a UTI [24] or those with a community-acquired pneumonia [25].…”

Treatment of Skin and Soft Tissue Infections in a Pediatric Observation Unit

“…Consistent with prior reports, we observed a low yield of likely pathogens from blood culture analysis (2.9%) among children with SSTIs. 3,8,[12][13][14] The utility of blood culture in non-critically ill children with an SSTI is not supported by these results.…”

Pediatric Cellulitis: A Red-Hot Concern

“…In one recent study by Malone et al, over 90% of children admitted to the hospital for SSTIs had laboratory investigation, including blood cultures, but <1% of patients had a positive culture. 8 In fact, in their study, there were no true positive blood cultures and length of stay was nearly 1 day longer if a culture had been ordered for a patient with an uncomplicated SSTI. This highlights not only the lack of utility, but also the potential harm to patients that could result from obtaining blood cultures in uncomplicated SSTIs, since a false positive blood culture often results in hospitalization or prolonged hospitalization, further laboratory testing and an extended antibiotic course.…”