Specific PCR, bacterial culture, serology and pharyngeal sampling to enhance the aetiological diagnosis of cellulitis

Toleman, Michelle S.; Vipond, Ian B.; Brindle, Richard

doi:10.1099/jmm.0.000191

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…The use of latex agglutination techniques and direct immunofluorescence on skin biopsy specimens increases the yield and has shown that β haemolytic streptococci, usually group A streptococci (GAS) or group G, represent the most prominent bacteria in studies of cellulitis and erysipelas, accounting for almost 80% of isolated organisms 45 Molecular testing6 and serology7 have been found to be of variable value but can improve the yield, especially if the patient has received antibiotics 8. It is probable that Staphylococcus aureus is not the causative agent in most cases where it was isolated, adopting an opportunistic bystander role.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis

et al. 2017

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ObjectiveTo compare flucloxacillin with clindamycin to flucloxacillin alone for the treatment of limb cellulitis.DesignParallel, double-blinded, randomised controlled trial.SettingEmergency department attendances and general practice referrals within 20 hospitals in England.InterventionsFlucloxacillin, at a minimum of 500 mg 4 times per day for 5 days, with clindamycin 300 mg 4 times per day for 2 days given orally versus flucloxacillin given alone.Main outcome measuresThe primary outcome was improvement at day 5. This was defined as being afebrile with either a reduction in affected skin surface temperature or a reduction in the circumference of the affected area. Secondary outcomes included resolution of systemic features, resolution of inflammatory markers, recovery of renal function, reduction in the affected area, decrease in pain, return to work or normal activities and the absence of increased side effects.Results410 patients were included in the trial. No significant difference was seen in improvement at day 5 for flucloxacillin with clindamycin (136/156, 87%) versus flucloxacillin alone (140/172, 81%)—OR 1.55 (95% CI 0.81 to 3.01), p=0.174. There was a significant difference in the number of patients with diarrhoea at day 5 in the flucloxacillin with clindamycin allocation (34/160, 22%) versus flucloxacillin alone (16/176, 9%)—OR 2.7 (95% CI 1.41 to 5.07), p=0.002. There was no clinically significant difference in any secondary outcome measures. There was no significant difference in the number of patients stating that they had returned to normal activities at the day 30 interview in the flucloxacillin with clindamycin allocation (99/121, 82%) versus flucloxacillin alone (104/129, 81%)—adjusted OR 0.90 (95% CI 0.44 to 1.84).ConclusionsThe addition of a short course of clindamycin to flucloxacillin early on in limb cellulitis does not improve outcome. The addition of clindamycin doubles the likelihood of diarrhoea within the first few days.Trial registration numberNCT01876628, Results.

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Section: Introductionmentioning

confidence: 99%

Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis

et al. 2017

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“…[ 13 ] Serological evidence for streptococcal infection with negative culture or PCR is conflicting. [ 25 , 26 ]…”

Section: Discussionmentioning

confidence: 99%

“…As noted above, serological evidence for a streptococcal etiology of cellulitis is conflicting. [ 25 , 26 ] In a planned larger study, we will add serological classification to the algorithm shown in Fig 1 , and this may result in some of the “indeterminate” lesions being classified as confirmed infected cases. For example, perhaps the rightmost controls in Fig 3 might have positive serological evidence of a streptococcal infection.…”

Section: Limitationsmentioning

confidence: 99%

Toward an Objective Diagnostic Test for Bacterial Cellulitis

Pallin¹,

Bry²,

Dwyer³

et al. 2016

PLoS ONE

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BackgroundPrior studies repeatedly showed that cultures of skin lesions diagnosed as "cellulitis" are usually negative. However, lack of a gold standard for diagnosis (against which culture might be judged) and failure to assess the human immune response are important limitations of prior work. In this pilot study, we aimed to develop a criterion standard for research on bacterial cellulitis, to evaluate the sensitivity of procalcitonin for bacterial cellulitis, and to use gene expression analysis to find other candidate diagnostic markers.MethodsWe classified lesions via biopsies, 16s rRNA gene detection, culture, and histopathology. We quantified procalcitonin expression in blood. We also used Nanostring technology to quantify transcription of immunomodulators that may distinguish cases from inflamed controls.ResultsOf 28 participants, 15 had a clinical diagnosis of cellulitis, six had a diagnosis of non-infectious dermatitis, and seven were normal volunteers. Of the “cellulitis” patients, three (20%) had pathogens isolated, and were designated confirmed cases. Procalcitonin was undetectable in all three. HLA-DQA1 was expressed 34-fold more in confirmed cases vs. controls (fold change of geometric mean). Heat maps depicting multiplex gene expression analysis revealed a distinct profile of gene expression in confirmed cases relative to comparators.ConclusionsMost “cellulitis” patients had microbiologically-negative biopsies. Procalcitonin was undetectable, and HLA-DQA1 elevated, in confirmed bacterial cases. Multivariable transcriptomic profiling results supported our algorithm’s ability to identify patients with true bacterial cellulitis. A larger sample may allow discovery of an immunological signature capable of distinguishing bacterial cellulitis from its mimics in clinical practice.

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“…11 It is probable that Staphylococcus aureus was not the causative agent in most cases where it was isolated, adopting an opportunistic bystander role. 10 This is supported by studies which demonstrate no extra benefit when adding an antibiotic active against met(h)icillin resistant S.aureus (MRSA) in the presence of MRSA carriage. 12 Four case-control studies focused on cellulitis of the leg.…”

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confidence: 99%

“…Classical testing with swabs or blood cultures only give a definite microbiological result in about 20 per cent of cases. 10 However, the use of latex agglutination techniques and direct immunofluorescence on skin biopsy specimens increases the yield and has clearly shown that beta-haemolytic streptococci (usually group A or group C/G) is found in almost 80% of isolated organisms. 11 It is probable that Staphylococcus aureus was not the causative agent in most cases where it was isolated, adopting an opportunistic bystander role.…”

mentioning

confidence: 99%