Risk factors for bacteremia in patients with limb cellulitis

Abstract

The aim of this study was to identify the risk factors for bacteremia in patients with limb cellulitis. Using the administrative and microbiology laboratory databases of a community teaching hospital, a review was conducted of all cases of community-acquired limb cellulitis that occurred during the period 1997-2004 and in which blood cultures had been performed. A comparison of demographical, clinical, and analytical data of patients with bacteremia versus patients without bacteremia was performed by univariate and multivariate analyses. Of 2,678 patients with cellulitis who presented to the hospital's emergency department, 308 were diagnosed with limb cellulitis and had blood cultures. Of these, 57 (18.5%) had bacteremia. In 24 of the 57 (42.1%) patients with bacteremia, the microorganism isolated in blood cultures was non-group-A beta-hemolytic Streptococcus, and in another 14 (24.6%), the microorganism identified was a gram-negative bacterium. Staphylococcus aureus was determined as the cause of bacteremia in just 6 (10.5%) patients and group A Streptococcus in 2 (3.5%). By logistic regression analysis, the following factors were associated with bacteremia: absence of previous antibiotic treatment (OR 5.3, 95% CI 1.4-20.3), presence of two or more comorbid factors simultaneously (OR 4.3, 95% CI 1.6-11.7), length of illness<2 days OR 2.44, 95% CI 1.07-5.56), and proximal limb involvement (OR 6, 95% CI 3.03-12.04). Patients with limb cellulitis who exhibit any of these characteristics are at increased risk of bacteremia. In such patients, it is imperative that blood cultures be performed.

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].…”

The Era of Molecular and Other Non-Culture-Based Methods in Diagnosis of Sepsis

“…However, several factors such as empirical antibiotic therapy initiated before blood sampling or the presence of fastidious pathogens may have a negative impact on the diagnostic yield of blood cultures even when a bloodstream infection is strongly suspected (48,51,65,78,79,98,131,136,153,204). These technical limitations will not be eliminated by significant improvements in this diagnostic technique.…”

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

“…Includes arterial grafts, arteriovenous fistulas or shunts, insulin infusion pumps, peripheral dialysis catheters, and internal orthopedic implants. Peralta et al reviewed the records of patients with limb cellulitis in a teaching hospital to identify predictors of bacteremia [9]. Among 308 patients (among 2,678 patients presenting to the hospital with cellulitis) having blood culture, 57 (18.5%) had bacteremia.…”