Clinical outcomes of bacteraemia in cellulitis of the leg

Infections of the blood are associated with high mortality and morbidity. In cellulitis, the utility of blood cultures remains controversial because of their relatively low bacterial yield. However, some important but less well studied aspects include risk factors for bacteraemia, the effects of bacteraemia on the length of hospitalization and on morbidity and mortality rates.

To determine the incidence of bacteraemia in cellulitis in an inpatient cohort; to identify risk factors for bacteraemia in cellulitis; and to assess length of hospitalization stay, rate of recurrence of cellulitis, and mortality in patients with cellulitis and bacteraemia.

Records of 214 patients diagnosed with cellulitis were reviewed. Blood cultures, length of hospitalization stay, rate of recurrence of cellulitis, mortality, coexistent dermatoses and local factors predisposing to cellulitis and comorbidities were analyzed.

The incidence of bacteraemia was 10.8%. Mean duration of hospitalization was longer (P < 0.01) and recurrence (P < 0.01) was higher in patients with bacteraemia. There was no difference in mortality between patients with and patients without bacteraemia (P = 0.47). Risk factors for bacteraemia included lymphoedema (P < 0.01), presence of an ipsilateral orthopaedic implant (P < 0.01), total white blood cell (WBC) count > 13.5 × 10(6) μL (P < 0.01, liver cirrhosis (P = 0.02) and chronic kidney disease (P = 0.04).

Blood cultures should be performed for patients with cellulitis who have factors increasing the risk of bacteraemia, such as presence of lymphoedema, ipsilateral orthopaedic device implantation, leucocytosis of > 13.5 × 10(6) μL, liver cirrhosis or chronic kidney disease, and other forms of immunosuppression. Bacteraemia in cases of cellulitis of the leg is a prognostic factor for increased length of hospitalization stay and recurrence of cellulitis.