High yield of blood cultures in the etiologic diagnosis of cellulitis, erysipelas, and cutaneous abscess in elderly patients

Incidence and Causes of Cellulitis Among Patients at Tupua Tamasese Meaole Hospital in Upolu, Samoa in 2019

OBJECTIVE

To study the incidence and causes of cellulitis in patients who visited the only tertiary hospital in Samoa, i.e., Tupua Tamasese Meaole (TTM) Hospital, in 2019.

METHOD

Of the total of 14,198 patients who presented to TTM Hospital in 2019, a chart review of all 258 patients who presented with cellulitis was conducted. All charts with the final primary admitting diagnosis of cellulitis were extracted. No exclusion criteria were employed, and raw data were analyzed manually.

RESULTS

Of the 14,198 patients who sought care at TTM Hospital in 2019, 258 patients received care for cellulitis. This represents an incidence rate of 1.8%. Most patients were male (62.4%). Those in the age group of 41 to 80 years old accounted for 79.5% of the total. The leg (94.6%) was the major site of infection. Of those who had blood cultures drawn, 76.4% had negative results. Of the 56 patients with positive microbial growth, Staphylococcus and Streptococcus species accounted for a combined total of 71.4% of the cases. The mainstay of antibiotic treatment was flucloxacillin alone or in conjunction with other antibiotics (92.2%). Of the many comorbidities affecting patients, diabetes (44.2%) was the most prevalent. Hospital admission, ranging from three to 10 days was needed in 63.5% of patients.

CONCLUSION

The incidence rate of cellulitis at TTM in 2019 was 1.8%, which was marginally higher than noted in other parts of the world. Male patients and people over the age of 40 years are affected the most. The leg is affected the most mainly by Staphylococcus and Streptococcus species. Flucloxacillin is the main antibiotic used to treat cellulitis at the TTM Hospital. From the data analyses, it is inferred that a large proportion of patients who presented had moderate to severe cellulitis.

Factors Associated With Blood Culture Contamination in Rural Hospitals in Japan: A Cross-Sectional Study

Background Blood culture, a cornerstone diagnostic test, is paramount for identifying bacteremia due to serious infections. However, its accuracy is jeopardized by contamination, often due to inappropriate collection procedures. Resource constraints and a limitation in specialized staff can heighten contamination risks in rural hospitals, underscoring the need to understand the associated demographics and conditions. This study aimed to elucidate the demographics and conditions associated with heightened blood culture contamination risk in rural hospitals to optimize testing practices and improve patient care. Methods A single-center, cross-sectional study was conducted in Unnan City Hospital, Unnan, Japan with participants suspected of having bacteremia. Data from the electronic medical records of 455 patients were analyzed using multivariate logistic regression with contamination as the dependent variable. Results Of the 455 patients who underwent blood culture testing, 321 and 134 tests were negative and positive for contamination, respectively. Older age and blood obtained from arteries were associated with a reduced risk of contamination (odds ratio (OR)=0.97; p=0.012, and OR=0.17; p=0.00069, respectively). Patients with dependencies exhibited an increase in contamination risk (OR=1.81; p=0.044). Patients admitted for infection demonstrated a reduced likelihood of sample contamination (OR=0.44; p=0.0034). The predominant organisms identified varied, with Escherichia coli being more frequent in uncontaminated blood samples and Staphylococcus epidermidis in the contaminated samples. Conclusion This study reveals a complex relationship between patient demographics, clinical practices, and the risk of contamination. Factors such as age, dependency status, and reason for admission were associated with sample contamination. Enhanced procedural stringency, microbial surveillance, and continuous training could mitigate these risks, particularly in resource-constrained settings. Identifying and understanding the factors influencing blood culture contamination can significantly bolster clinical practice in rural settings. While this study provides foundational insights, future research can deepen our understanding, ensuring the refinement of patient care protocols in similar environments.