Taniguchi Tomohiro, Tsuha Sanefumi, Shiiki Soichi, Narita Masashi, Teruya Mariko, Hachiman Teruyuki, Kogachi Noriyasu
Division of Infectious Diseases, Department of Internal Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, Japan.
Microbiology Laboratory, Okinawa Chubu Hospital, Uruma, Okinawa, Japan.
Open Forum Infect Dis. 2022 Jun 24;9(7):ofac317. doi: 10.1093/ofid/ofac317. eCollection 2022 Jul.
Cellulitis is a common disease in the elderly, and detecting etiologic organisms with blood cultures is difficult because of the low positive rate and occasional skin contamination. Therefore, routine blood cultures are not recommended for uncomplicated cellulitis. However, it is unclear whether blood culture collection for the diagnosis of cellulitis in elderly patients is useful.
This single hospital-based observational study was performed between April 2012 and March 2015 in Okinawa, Japan. All enrolled patients were aged 15 years or older and admitted to the Division of Infectious Diseases with suspected cellulitis, erysipelas, and cutaneous abscess. Two routine sets of blood cultures were obtained.
Two hundred and twenty-one patients were enrolled. The median age was 77 years. The proportion of bacteremia was 21.7% for all patients (48/221), 8.5% (4/47) for those <65 years, and 25.3% (44/174) for those ≥65 years old ( = .013). The skin contamination rate was 0.9% (2/221). The most common pathogen was (62.5%). Gram-negative bacteremia not susceptible to cefazolin was detected in 8.3%. Cefazolin and ampicillin were the first- and second-most commonly used therapies. Anti-methicillin-resistant therapy was required in 3.6% of patients. In addition to age and severe infection, shaking chills and white blood count ≥13 000 cells/µL were independent risk factors of bacteremia.
Two routine sets of blood cultures are recommended for the precise diagnosis and appropriate treatment of cellulitis in elderly patients, especially in patients with shaking chills or leukocytosis.
蜂窝织炎是老年人的常见疾病，由于血培养阳性率低且偶尔存在皮肤污染，通过血培养检测病原体较为困难。因此，不建议对无并发症的蜂窝织炎进行常规血培养。然而，对于老年患者蜂窝织炎诊断时进行血培养采集是否有用尚不清楚。
这项基于单一医院的观察性研究于2012年4月至2015年3月在日本冲绳进行。所有纳入的患者年龄在15岁及以上，因疑似蜂窝织炎、丹毒和皮肤脓肿入住传染病科。采集两组常规血培养标本。
共纳入221例患者。中位年龄为77岁。所有患者的菌血症比例为21.7%（48/221），年龄<65岁的患者为8.5%（4/47），≥65岁的患者为25.3%（44/174）（P = 0.013）。皮肤污染率为0.9%（2/221）。最常见的病原体是……（62.5%）。对头孢唑林不敏感的革兰阴性菌血症检出率为8.3%。头孢唑林和氨苄西林是最常用和第二常用的治疗药物。3.6%的患者需要抗耐甲氧西林……治疗。除年龄和严重感染外，寒战和白细胞计数≥13000个细胞/微升是菌血症的独立危险因素。
对于老年患者蜂窝织炎的精确诊断和恰当治疗，建议采集两组常规血培养标本，尤其是对有寒战或白细胞增多的患者。
