Blood Cultures in the Evaluation of Children With Cellulitis

Abstract

Blood cultures are not cost-effective and are more frequently contaminated than positive in the evaluation of a patient with uncomplicated cellulitis. Since introduction of the H influenzae type b vaccine, the most common organisms are streptococci. Using a BNR = 0.20 as a threshold for sending blood cultures, we would have missed one positive culture, but would have avoided blood cultures in 213 patients (88%) with an estimated savings of $42 850.

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

“…The sample size estimate assumes that 2% is the true prevalence of bacteremia in children with SSTIs. 7 …”

“…2,15 Similar falsepositive blood culture rates were also noted in the 1998 study by Sadow and Chamberlain, who examined the utility of blood cultures in the post-Haemophilus influenzae vaccination era. 7 They collected data in 1994-1995, before the introduction of the varicella vaccine in 1995 and the pneumococcal conjugate vaccine in 2000. They detected 5 cases of bacteremia, of which 3 were associated with varicella and one was Streptococcus pneumoniae.…”

“…In the pre-Haemophilus influenzae vaccine era, the rate of SSTI-associated bacteremia was ∼20%, 6 but after introduction of the H. influenzae vaccine, the rate decreased to 2%. 7 In 1998, Sadow and Chamberlain reported that bacteremia during SSTI was largely associated with superinfected lesions originating from active varicella infection, 7 which is now much less common because of routine childhood vaccination. 8 However, since that study was published, the widespread emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been implicated in invasive infections and now accounts for 45% to 75% of SSTIs.…”

Evaluation, management, and outcome of focal bacterial infections (FBIs) in nontoxic infants under two months of age

“…The frequency of bacteremia in pediatric patients with periorbital cellulitis has been studied, with some authors suggested more selective use of LP in patients with these localized soft-tissue infections in the older infant or child. 25,26 Unfortunately, there were not enough patients under 60 days of age in either study from which to draw conclusions. In our study, a total of 5 patients presented with periorbital cellulitis: 2 afebrile and 3 febrile, including the 47-day-old febrile infant with coexisting pneumococcal bacteremia.…”

Indications of Collecting Blood Culture and Necessity of Educations [Kan Kulturu Alma Nedenleri ve Egitimin Gerekliligi]

“…Eğitim verilmesinin mali etkilerinin incelendiği bir çalışmada %3,9 (212/5402) olan yalancı pozitif sonuçların eğitim sonrasında %1,6'a (35/2153) gerilediği ve hastanenin bu gelişmeden yılda yaklaşık 250 bin dolar kazancının olduğu hesaplanmıştır [4]. Komplike olmayan selülitli çocuklar için kan kültürü alınmaması gerektiğinin belirtildiği diğer bir çalışmada, selülitin kan kültürü görülmeksizin kolaylıkla tedavi edilebileceği ve az sayıda bakteriyeminin tespit edilmemesi karşılığında ciddi bir mali kayıptan (tahminen yıllık 213 hasta için $42.850 dolar) kurtulunabileceği belirtilmiştir [8].…”