From the Guidelines
The patient's skin culture results indicate no significant anaerobic bacterial infection, and therefore, no antimicrobial treatment is necessary based on these results alone. The skin culture shows no anaerobic bacterial growth after 72 hours of incubation, with the culture being held for a total of 5 days for complete assessment. The Gram stain examination reveals no cells or bacteria visible under microscopic examination. These findings suggest a negative culture result, indicating there is no significant anaerobic bacterial infection present in the sampled skin area 1.
However, if the patient is showing clinical signs of infection, further investigation may be warranted as some organisms might not grow well in culture conditions or the sampling might have missed the infected area. The laboratory will continue monitoring the culture for the full 5-day period and will issue an updated report if any growth occurs during the remaining incubation time.
According to the 2018 WSES/SIS-E consensus conference, the use of antimicrobial therapy is an adjuvant treatment and must be combined with early surgical debridement 1. The conference recommends broad-spectrum coverage to cover Gram-positive, Gram-negative, and anaerobic organisms until culture-specific results and sensitivities are available.
Some key points to consider in the management of skin and soft-tissue infections include:
- The importance of early surgical debridement in the treatment of necrotizing infections 1
- The use of broad-spectrum antimicrobial therapy to cover Gram-positive, Gram-negative, and anaerobic organisms 1
- The consideration of procalcitonin monitoring to guide antimicrobial discontinuation 1
- The need to interpret culture results in the context of the patient's clinical presentation 1
It is essential to note that the patient's clinical presentation and medical history should be taken into account when making treatment decisions. The patient's temperature, heart rate, and erythema extension should be monitored, and if necessary, a short course of antibiotics may be required 1.
From the Research
Skin Flora Culture Results
- No anaerobic growth after 72 hours, with anaerobic culture held for 5 days and a further report to be issued if growth occurs 2, 3
- The results of the skin flora culture are important in guiding empirical antibiotic therapy, as they can inform the risk of infection from resistant organisms 4, 5
Gram Stain Results
- No cells or bacteria seen on Gram stain, which can be used to guide empirical antimicrobial therapy in patients with suspected sepsis 4, 6
- Gram stain results can be used in combination with patient categorization and clinical presentation to guide empirical treatment of bloodstream infections 4
Empirical Antibiotic Therapy
- Empirical antibiotic therapy should be guided by the results of skin flora culture and Gram stain, as well as the patient's clinical presentation and risk factors for resistant organisms 2, 3, 5
- The use of broad-spectrum antibiotics should be minimized to reduce the development of resistance, and targeted therapy should be used whenever possible 3, 5
- Direct sensitivity testing can be used to guide empirical antibiotic therapy, but may not always be reliable, particularly for certain antibiotic-organism combinations 6