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Published on: October 15, 2014
Blood cultures in the evaluation of uncomplicated skin and soft tissue infections
Jay R Malone1, Sarah R Durica, David M Thompson
1Sections of General and Community Pediatrics, The University of Oklahoma, Oklahoma City, OK, USA.
Insights
Blood cultures are not useful for immunocompetent children hospitalized with uncomplicated skin and soft tissue infections (SSTIs). This practice is linked to a longer hospital stay without providing diagnostic benefits.
Area of Science:
- Pediatric infectious diseases
- Hospital epidemiology
- Clinical microbiology
Background:
- Blood cultures are frequently performed in pediatric patients with skin and soft tissue infections (SSTIs).
- Limited evidence supports the routine use of blood cultures in this patient population.
Purpose of the Study:
- To evaluate the diagnostic yield of blood cultures in immunocompetent children admitted with SSTIs.
- To determine the impact of blood cultures on length of hospital stay (LOHS) in these patients.
Main Methods:
- Retrospective review of medical records for children hospitalized with SSTIs or complicated SSTIs (cSSTIs) between 2007 and 2009.
- Comparison of blood culture positivity rates and LOHS between SSTI and cSSTI groups.
Main Results:
- No positive blood cultures were observed in the uncomplicated SSTI group (n=482).
- 12.5% of blood cultures were positive in the cSSTI group (n=98).
- Obtaining blood cultures in the SSTI group was associated with a significant increase in mean LOHS (P = .044).
Conclusions:
- Blood cultures lack utility in the evaluation of immunocompetent children with uncomplicated SSTIs.
- Routine blood cultures in this setting are associated with an approximate one-day increase in mean LOHS, suggesting unnecessary resource utilization.
Background:
Blood cultures are often obtained in children hospitalized with skin and soft tissue infections (SSTIs). Because little evidence exists to validate this practice, we examined the yield of blood cultures in the evaluation of immunocompetent children with SSTIs.
Methods:
Medical records were reviewed for all children admitted between January 1, 2007 and December 31, 2009 after emergency department evaluation and diagnosis of cellulitis or abscess. We compared patients with SSTIs (n = 482) with those with complicated SSTIs (cSSTIs; n = 98). A cSSTI was defined as surgical or traumatic wound infection, need for surgical intervention, or infected ulcers or burns. The SSTI group included patients without complicating factors.
Results:
None of the patients in the SSTI group had a positive blood culture. In the cSSTI group, 12.5% of blood cultures were positive. The mean length of hospital stay (LOHS) of children with SSTIs was shorter than that of those with cSSTIs (P < .001). In the SSTI group, obtaining a blood culture was associated with a higher mean LOHS (P = .044).
Conclusions:
Blood cultures are not useful in evaluating immunocompetent children who are admitted to the hospital with uncomplicated SSTIs, and they are associated with a nearly 1-day increase in mean LOHS.
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