Pathogen identification of abscesses and cellulitis

doi:10.1016/S0196-0644(86)80577-7

Annals of Emergency Medicine

Volume 15, Issue 3, March 1986, Pages 329-332

https://doi.org/10.1016/S0196-0644(86)80577-7 Get rights and content

The goal of culturing abscesses and/or cellulitis is to identify the offending pathogen in order to understand and treat the infection. Abscesses respond to incision and drainage. Antibiotics are not indicated in the patient with normal host defense, and thus in these patients cultures and Gram stains are not indicated. In immunocompromised patients, in patients with abscesses of the central face, and in those with abscesses that contain gas or involve muscle or fascia, Gram stain, culture, and antibiotics are necessary. The Gram stain is a reliable indicator of sterile abscesses, abscesses in pure culture (especially Staphylococcus aureus), and those in mixed anaerobic culture. Location and odor of abscesses are clues to offending bacteria. Cultures of tissue or blood in patients with cellulitis usually are positive in less than 40% of cases, regardless of the technique used. Hemophilus influenzae cellulitis in pediatric patients is an exception; blood cultures are positive in more than two-thirds of cases. Although not specific, certain types of cellulitis show different clinical characteristics. Treatment with elevation, warm soaks, and antibiotics is still the mainstay of therapy. Gram stain and culture are limited to those patients who do not respond to initial therapy or who are immunocompromised.

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Cited by (15)

Blood culture results do not affect treatment in complicated cellulitis
2013, Journal of Emergency Medicine
Citation Excerpt :
Cellulitis is among the top 10 complaints in the ambulatory care setting, including the Emergency Department (ED). The causative organisms are typically skin flora, with Staphylococcus and Streptococcus species being the most commonly isolated pathogens (1–3). In general, empiric treatment based on knowledge of local resistance patterns and typical pathogens is sufficient to adequately treat the majority of cellulitis without the need for direct isolation of the offending organism.
Cellulitis, a frequently encountered complaint in the Emergency Department, is typically managed with antibiotics. There is some debate as to whether obtaining blood cultures and knowing their results would change the management of cellulitis, although most authors argue that information from blood cultures does not change the empirical management of uncomplicated cellulitis. However, for complicated cellulitis (as defined by the presence of significant comorbidity), there is considerable disagreement and lack of evidence as to the utility of blood cultures.
Our aim was to determine the role of blood cultures in the management of complicated cellulitis.
This retrospective chart review assessed the utility of obtaining blood cultures in complicated cellulitis (as defined by active chemotherapy, dialysis, human immunodeficiency virus/acquired immune deficiency syndrome, diabetes, or organ transplantation) vs. a cohort of individuals without medical comorbidity.
Six hundred and thirty-nine patients were identified, 314 of which were deemed cases and 325 controls. Within the cases, 29 of 314 returned as positive blood cultures vs. 17 of 325 positive blood culture controls within the cases (p = 0.05; odds ratio = 1.84; 95% confidence interval 0.99–3.43). A clinically significant change in management (a change in the class of antibiotic) was found in 6 of 314 cases vs. 4 of 325 controls (p = 0.578; odds ratio = 1.5525; 95% confidence interval 0.434–5.5541).
Within this cohort of patients with complicated cellulitis, blood cultures rarely changed management from empirical coverage.
Maxillofacial swelling and infections
2010, Clinical Pediatric Emergency Medicine
Citation Excerpt :
Cellulitis caused by streptococci responds well to antibiotic therapy without surgery. H influenzae cellulitis in pediatric patients is an exception; blood cultures are positive in more than two thirds of cases.27 Erysipelas is an acute superficial cutaneous cellulitis that commonly occurs in elderly and immunocompromised patients.
A variety of conditions may result in maxillofacial swelling in children, prompting a visit to the emergency department. Some of these diagnoses are self-limiting, whereas others may be life-threatening. Furthermore, the pediatric population is at significant risk for problems that rarely occur in adults. Emergency medicine providers must be able to identify these conditions, especially if specialty consultation is required. Some of the most common and significant causes of maxillofacial swelling in children are reviewed to help familiarize the practitioner with their presentation, causes, and available treatment options.
Incision and Drainage
2008, Pediatric Emergency Medicine
Incision and Drainage
2007, Pediatric Emergency Medicine
Incision and Drainage/Needle Aspiration of Cutaneous Abscesses
2005, Pediatrics
Special considerations for the pediatric emergency patient
2000, Emergency Medicine Clinics of North America
Citation Excerpt :
Correct diagnosis and aggressive treatment result in rapid resolution of symptoms within 24 hours. Potentially serious complications include local dissemination of infection by direct invasion of the orbits, or cavernous sinus or hematogenous spread with associated sepsis or meningitis.14,24,33,34 Children with lower face infection are often older (age > 5 y), and specific cause can be frequently identified.
This article discusses pediatric maxillofacial infections and secondary growth deformities associated with orofacial trauma. In pediatric infection, origin, diagnosis, and management are different from adults and few clinicians have extensive experience in these area. Post-traumatic growth deformities are unique to children and represent the fourth dimension of patient care, that is, changes occurring over time.

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: Presented at the Winter Symposium Advances Track of the American College of Emergency Physicians in San Diego, California, April 1985.

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Annals of Emergency Medicine

References (21)

Management and microbiology of cutaneous abscesses

JACEP

Common bacterial infections of the skin

Primary Care

The use of penicillin and sulphonamides in the treatment of suppuration

Lancet

Cellulitis: Bacterial etiology, clinical features and laboratory findings

J Pediatrics

Systemic Haemophilus influenzae disease: An overview

J Pediatr

Treatment of cutaneous abscess: A double-blind clinical study

Ann Emerg Med

Fundamental Skills in Surgery

Cutaneous abscesses, anaerobic and aerobic bacteriology and outpatient management

Ann Intern Med

Perirectal abscesses in children

Am J Dis Child

Aerobic and anaerobic bacteriology of perirectal abscesses in children

Pediatrics

Cited by (15)

Blood culture results do not affect treatment in complicated cellulitis

Maxillofacial swelling and infections

Incision and Drainage