Meislin H W
Ann Emerg Med. 1986 Mar;15(3):329-32. doi: 10.1016/s0196-0644(86)80577-7.
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.
培养脓肿和/或蜂窝织炎的目的是识别致病病原体，以便了解和治疗感染。脓肿需切开引流。宿主防御功能正常的患者无需使用抗生素，因此这类患者也无需进行培养和革兰氏染色。免疫功能低下的患者、面部中央有脓肿的患者、脓肿含有气体或累及肌肉或筋膜的患者，革兰氏染色、培养及使用抗生素是必要的。革兰氏染色是无菌性脓肿、纯培养脓肿（尤其是金黄色葡萄球菌）及混合厌氧培养脓肿的可靠指标。脓肿的位置和气味是提示致病细菌的线索。无论采用何种技术，蜂窝织炎患者的组织或血液培养通常在不到40%的病例中呈阳性。儿童患者的流感嗜血杆菌蜂窝织炎是个例外；超过三分之二的病例血培养呈阳性。虽然不具有特异性，但某些类型的蜂窝织炎表现出不同的临床特征。抬高患肢、热敷及使用抗生素治疗仍是主要治疗方法。革兰氏染色和培养仅限于对初始治疗无反应或免疫功能低下的患者。
