What is the relationship between bacteremia and cellulitis?

From the Guidelines

Bacteremia from cellulitis is a rare but serious complication, and blood cultures are only recommended in specific cases, such as patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites, as stated in the 2014 guidelines by the Infectious Diseases Society of America 1.

Relationship Between Bacteremia and Cellulitis

The relationship between bacteremia and cellulitis is that bacteremia can occur as a complication of cellulitis, although it is not a common occurrence. According to the guidelines, blood culture results are positive in only 5% of cases of cellulitis 1.

Diagnosis and Management

The diagnosis and management of cellulitis involve the use of antibiotics active against streptococci, with a recommended duration of antimicrobial therapy of 5 days, which can be extended if the infection has not improved within this time period 1.

Recommended Treatment

The recommended empiric regimen for severe infections includes vancomycin plus either piperacillin-tazobactam or imipenem/meropenem, as stated in the 2014 guidelines by the Infectious Diseases Society of America 1.

Key Points to Consider

• Bacteremia is a rare complication of cellulitis, occurring in only 5% of cases 1.
• Blood cultures are not routinely recommended for patients with cellulitis, but may be considered in specific cases 1.
• The recommended duration of antimicrobial therapy for cellulitis is 5 days, which can be extended if the infection has not improved within this time period 1.
• The use of antibiotics active against streptococci is recommended for the treatment of cellulitis, with a focus on penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin for typical cases 1.

From the Research

Relationship Between Bacteremia and Cellulitis

• Bacteremia is a condition where bacteria are present in the blood, and it can be associated with various infections, including cellulitis 2.
• Cellulitis is an acute inflammation of the dermis and subcutaneous tissue, usually complicating wounds, ulcers, or dermatosis, and it can lead to bacteremia in some cases 2.
• The prevalence of bacteremia in patients with cellulitis has been reported to be around 8.6%, with the most frequently isolated bacteria being Group G Beta haemolytic Streptococcus (33%) 2.

Risk Factors for Bacteremia in Cellulitis

• Certain variables have been significantly associated with the occurrence of positive blood cultures in patients with cellulitis, including:
  • Diabetes (41.7% vs. 14.1%; p = 0.02; OR 4.4) 2
  • Positive skin and soft tissue culture (75% vs. 35.2%; p = 0.01; OR 5.5) 2
  • Alcoholism (16.7% vs. 3.9%; p = 0.01; OR 4.9) 2
  • Chronic obstructive pulmonary disease (16.7% vs. 0.78%; p = 0.01; OR 25.4) 2

Treatment of Bacteremia

• The treatment of bacteremia, including methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, often involves the use of antibiotics such as vancomycin, ceftaroline, and daptomycin 3, 4, 5.
• Combination therapy with vancomycin and ceftaroline may be considered for patients with persistent MRSA bacteremia refractory to initial therapy 3.
• The empirical combination of vancomycin and a β-lactam for Staphylococcal bacteremia may improve infection-related clinical outcomes 4.