Trenchs Victoria, Hernandez-Bou Susanna, Bianchi Claudia, Arnan Mireia, Gene Amadeu, Luaces Carles
From the Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain.
Pediatr Infect Dis J. 2015 Sep;34(9):924-7. doi: 10.1097/INF.0000000000000768.
Blood cultures (BCs) are commonly performed on children admitted to hospital for skin and soft tissue infections (SSTIs). In recent years, this practice has been questioned in patients with uncomplicated SSTIs because of its low yield. At the same time, however, an increase in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has been described; its influence on rates of bacteremia in patients with SSTIs is unclear. The aims of the study were to describe the performance and the yield of BC in immunocompetent patients with uncomplicated SSTIs and to determine the prevalence of CA-MRSA as a causative agent in our area.
Retrospective study: immunocompetent patients younger than 18 years evaluated in the emergency department and admitted for uncomplicated SSTIs (cellulitis, abscess, impetigo or erysipelas) from July 1, 2010 to June 31, 2014 were included. Patients referred from other hospitals who were receiving parenteral antibiotics and patients with complicated SSTIs (surgical or traumatic wound infection, need for surgical intervention and infected ulcers or burns) were excluded.
We included 445 cases: 348 (78.2%) cellulitis, 78 (17.5%) abscess and 19 (4.3%) impetigo. BCs were performed on 353 (79.3%) patients. Two (0.6%; 95% confidence interval: 0.2-2.0%) were positive and 10 (2.8%; 95% confidence interval: 1.5-5.1%) contaminated. The positive BCs grew S. aureus and Streptococcus pyogenes. Wound cultures were performed on 148 (33.3%) patients; 98 (66.2%) were positive. In 22 (22.4%) patients CA-MRSA grew, accounting for 14.9% of overall wound cultures.
BCs are not useful in the management of immunocompetent patients admitted to the hospital with uncomplicated SSTIs. The prevalence of CA-MRSA is low in our area, but continuing careful surveillance is needed.
对于因皮肤和软组织感染（SSTIs）入院的儿童，通常会进行血培养（BCs）。近年来，由于其阳性率较低，这种做法在无并发症的SSTIs患者中受到质疑。然而，与此同时，社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染有所增加；其对SSTIs患者菌血症发生率的影响尚不清楚。本研究的目的是描述无并发症的SSTIs免疫功能正常患者血培养的表现和阳性率，并确定我们地区CA-MRSA作为病原体的患病率。
回顾性研究：纳入2010年7月1日至2014年6月31日在急诊科评估并因无并发症的SSTIs（蜂窝织炎、脓肿、脓疱病或丹毒）入院的18岁以下免疫功能正常患者。排除从其他医院转诊且正在接受胃肠外抗生素治疗的患者以及有并发症的SSTIs患者（手术或创伤性伤口感染、需要手术干预以及感染性溃疡或烧伤）。
我们纳入了445例病例：348例（78.2%）蜂窝织炎、78例（17.5%）脓肿和19例（4.3%）脓疱病。353例（79.3%）患者进行了血培养。2例（0.6%；95%置信区间：0.2 - 2.0%）呈阳性，10例（2.8%；95%置信区间：1.5 - 5.1%）被污染。血培养阳性结果培养出金黄色葡萄球菌和化脓性链球菌。148例（33.3%）患者进行了伤口培养；98例（66.2%）呈阳性。22例（22.4%）患者培养出CA-MRSA，占所有伤口培养结果的14.9%。
血培养对因无并发症的SSTIs入院的免疫功能正常患者的管理并无帮助。我们地区CA-MRSA的患病率较低，但仍需要持续仔细监测。
