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Blood culture associations in children with a diagnosis of cellulitis in the era of methicillin-resistant Staphylococcus aureus.

Cellulitis is defined as an “acute spreading infection of the skin that extends deeper than erysipelas and involves the subcutaneous tissues.”1 In the last 2 decades, we have seen an increase in cellulitis and overall skin and soft tissue infection (SSTI) diagnoses. During this time, the rate of emergency department (ED) visits for SSTI has doubled, and overall there has been a 50% increase in ambulatory visits.2,3 In addition, an exponential rise in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has occurred.4

The cause of cellulitis or nondrainable SSTI is frequently attributed to staphylococcal and streptococcal species, although this is complicated by the difficulty in obtaining culture proof of an organism.5–13 The inability to obtain proof of bacterial etiology in patients with cellulitis is typically due to the absence of a specific nidus of infection from which to culture. Leading edge cultures and fine-needle aspiration of the infected area have fallen from favor, but blood cultures continue to be used despite several studies illustrating that they tend to be low yield.11–17

Evaluative procedures of patients presenting with cellulitis may be physician-, hospital-, or region-dependent and tend to be variable. Previously published studies found that blood cultures in patients with cellulitis yield a low prevalence of bacteremia (0.7%–5%); however, most of these studies were completed before the recent surge in CA-MRSA and SSTIs.11–13 Due to increasing concern of CA-MRSA in cellulitis, antibiotic therapy directed toward methicillin-resistant S aureus (MRSA) has become standard, although it is not clear that the rise in cellulitis is attributable to CA-MRSA.18

The objective of the current study was to determine the incidence of clinically relevant blood cultures in an era of increasing MRSA prevalence. Secondary objectives include demographic features associated with blood …