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Timely testing essential to treat bacterial skin, subcutaneous infections
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Timely testing and diagnosis may be crucial to effectively treat bacterial infections of the skin and subcutaneous tissues, according to data presented at the 2014 American Academy of Dermatology Annual Meeting.
Elva Cardenas, MD, of the Hospital Angeles Leon in Mexico, and colleagues collected skin biopsies or aspirates from 47 patients with bacterial infections of the skin and subcutaneous tissues in patients who presented to a tertiary care center from November 2006 to November 2007. The mean age of the patients was 51.3 years, and they were followed and evaluated on days 15 and 30.
Researchers found that 87.5% of patients had community-acquired infections and 12.5% had nosocomial infections. All patients had at least one comorbid condition and 60.4% were considered immunosuppressed. The most common type of infection was cellulitis; 32 cases were documented and accounted for 66.7% of the study cohort, according to the study data.
Half of the study cohort had a positive culture. Of these, 66.7% had one bacterium isolated; 25% had two bacterium isolated; and 8.3% had three bacterium isolated. A total of 34 microorganisms were isolated from patients in the study. Half of isolated microorganisms responded to gram-positive bacteria; 38.2% responded to gram-negative bacteria; 5.8% responded to fungi; and 5.8% responded to mycobacteria. Escherichia coli accounted for 17.6% of clinical isolates; 14.7% were coagulase-negative Staphylococcus; and 11.7% were Staphylococcus aureus.
Initial treatment was effective in 15 of 24 patients with a positive culture. Nine (37.5%) patients with a positive culture received inadequate initial treatment. During follow-up, the cure rate was 54.2% on day 15 and 81.3% on day 30.
Researchers noted that patients with cirrhosis had more complications compared with noncirrhotic patients (70% vs. 15.8%). Patients with cirrhosis had a slower healing rate 15 days after baseline compared with participants with immunosuppression and diabetes.
“Inappropriate initial treatment was very common in our cohort, establishing the need to obtain timely cultures and biopsies, especially in patients with cirrhosis and immunosuppression because complications are greater [for those patients] if adequate treatment is not installed,” the researchers concluded.
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Disclosure: Cardenas reports no relevant financial disclosures.