Blood Culture Not Useful in Pediatric Uncomplicated Skin Infections

By Reuters Staff

June 30, 2015

NEW YORK (Reuters Health) - Immunocompetent children with uncomplicated superficial skin and soft tissue infections (SSTIs) do not need to undergo blood cultures upon hospital admission, the authors of a new retrospective study conclude.

Blood cultures are often performed in patients with SSTIs who are hospitalized for parenteral antibiotic treatment, Dr. Susanna Hernandez-Bou of Hospital Sant Joan de Deu Barcelona in Spain and her colleagues write in their report, online June 10 in The Pediatric Infectious Disease Journal.

Widespread use of the Haemophilus influenza type b vaccine and the varicella vaccine have reduced rates of bacteremia in patients with uncomplicated SSTIs, they add, while no link between bacteremia and infection severity has been shown in these patients.

"According to these findings, the systematic practice of BC in patients with uncomplicated SSTIs has been questioned, but most of these studies were published before the rapid worldwide increase in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections," Dr. Hernandez-Bou and her team write.

In their region, the researchers add, the pneumococcal conjugated and varicella vaccines are not part of the official vaccination schedule, and there is little information about the prevalence of bacteremia or CA-MRSA in pediatric SSTI patients.

To investigate the diagnostic yield of blood culture in these patients, and determine how frequently SSTIs were caused by CA-MRSA, the researchers looked at 445 children who were admitted to their hospital for SSTI treatment. Cellulitis was the most common diagnosis, in 78.2% of the patients, while 17.5% had abscess and 4.3% had impetigo.

Blood cultures were done for 353 patients, two (0.6%) of whom tested positive, one with methicillin-sensitive S. aureus and one with S. pyogenes. Both patients did well with empiric antibiotic treatment. Ten of the blood cultures were contaminated.

Wound cultures were performed in a third of the patients in the study, and 98 (66.2%) of the wound cultures were positive. Twenty percent of the patients with cellulitis underwent a wound culture, versus 77% of the patients with abscess. S. aureus was identified in 82 patients, and 22 of these patients -- or 14.9% of the wound cultures -- had CA-MRSA.

During the four-year study period, prevalence of MRSA did not change. Patients' median hospital stay was four days, while patients who underwent blood cultures had a median stay of four days, versus three days for patients who did not have blood cultures.

"In our sample, no cases of bacteremia were detected among children with SSTIs caused by CA-MRSA," the researchers write. "Although this finding correlates with recent studies published in the United States, it has to be interpreted with caution because of the low number of patients with CA-MRSA analyzed. Therefore, continuous monitoring of both the rate and clinical features of patients with SSTIs caused by CA-MRSA is essential."

They conclude: "Blood culture is not useful in the management of immunocompetent well-appearing children admitted for uncomplicated SSTIs, and its routine practice should be avoided. The incidence of CA-MRSA is still low in our area, so empiric antibiotic prescribing should not be changed. Continuing careful surveillance is essential to detect epidemiological changes."

Dr. Hernandez-Bou did not respond to an interview request by press time.


Pediatr Infect Dis J 2015.


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