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Causative Bacteria and Proper Antibiotics Selection: a Prospective Investigation of 101 Patients with Cellulitis
Department of Dermatology, Tsuchiura Kyodo General Hospital
Yoshihiro MORIYAMA, Kazuma IWAMOTO, Masahiro KATAGIRI & Reiko KESSOKU
(Received June 29, 2017)
(Accepted November 14, 2017)
Key words: cellulitis, erysipelas, β-hemolytic Streptococcus, community-acquired methicillin-resistant Staphylococcus aureus, antimicrobial therapy

Skin and soft infections (SSTIs) comprise a diverse group of bacterial infections. In many patients with nonprulent SSTIs, bacterial pathogens tends to remain unknown because direct detection of the organism by blood and puncture culture is difficult. Although β-hemolytic Streptococcus (BHS) is believed to be the primary cause of cellulitis, this has been proved only by serological investigation and therapeutic response. On the other hand, community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is most widely detected by bacteriological investigation in purulent SSTIs in recent years.

Cellulitis is distinct from purulent SSTIs, and guidelines by the Infectious Diseases Society of America do not recommend CA-MRSA coverage for cellulitis as initial management, except for severe cases. Despite this, broad-spectrum antibiotics including anti-MRSA drugs are haphazardly prescribed due to physicians' concerns over the uncertainty of the established pathogen of cellulitis, which has led to the ominous emergence of bacterial resistance.

The aim of this prospective investigation was to evaluate the contribution of BHS to the etiology of cellulitis in our hospital, and we considered the necessity of antibiotics targeting CA-MRSA. BHS was considered as the pathogen in 59.4% (60 cases) of 101 patients. There was no need for MRSA-covering antibiotics in all 101 cases.

[ Kansenshogaku Zasshi 92: 115-119, 2018 ]

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