Journal article
Inability of Polymerase Chain Reaction, Pyrosequencing, and Culture of Infected and Uninfected Site Skin Biopsy Specimens to Identify the Cause of Cellulitis
Clinical infectious diseases, Vol.61(11), pp.1679-1687
12/01/2015
DOI: 10.1093/cid/civ655
PMID: 26240200
Abstract
Background. The cause of cellulitis is unclear. Streptococcus pyogenes, and to a lesser extent, Staphylococcus aureus, are presumed pathogens.
Methods. We conducted a study of adults with acute cellulitis without drainage presenting to a US emergency department research network. Skin biopsy specimens were taken from the infected site and a comparable uninfected site on the opposite side of the body. Microbiology was evaluated using quantitative polymerase chain reaction (PCR), pyrosequencing, and standard culture techniques. To determine the cause, the prevalence and quantity of bacterial species at the infected and uninfected sites were compared.
Results. Among 50 subjects with biopsy specimens from infected and uninfected sites, culture rarely identified a bacterium. Among 49 subjects with paired specimens from infected and uninfected sites tested with PCR, methicillin- susceptible S. aureus was identified in 20 (41%) and 17 (34%), respectively. Pyrosequencing identified abundant atypical bacteria in addition to streptococci and staphylococci. Among 49 subjects with paired specimens tested by pyrosequencing, S. aureus was identified from 11 (22%) and 15 (31%) and streptococci from 15 (31%) and 20 (41%) of the specimens, respectively. Methicillin-resistant S. aureus was not found by culture or PCR, and S. pyogenes was not identified by any technique.
Conclusions. The bacterial cause of cellulitis cannot be determined by comparing the prevalence and quantity of pathogens from infected and uninfected skin biopsy specimens using current molecular techniques. Methicillin-susceptible S. aureus was detected but not methicillin-resistant S. aureus or S. pyogenes from cellulitis tissue specimens. For now, optimal treatment will need to be guided by clinical trials. Noninfectious causes should also be explored.
Details
- Title: Subtitle
- Inability of Polymerase Chain Reaction, Pyrosequencing, and Culture of Infected and Uninfected Site Skin Biopsy Specimens to Identify the Cause of Cellulitis
- Creators
- Jonathan G. Crisp - Departments of Emergency Medicine.Sukhjit S. Takhar - Brigham and Women's HospitalGregory J. Moran - Ronald Reagan UCLA Medical CenterAnusha Krishnadasan - Departments of Emergency Medicine.Scot E. Dowd - MR DNA, Shallowater, Texas.Sydney M. Finegold - VA Greater Los Angeles Healthcare SystemPaula H. Summanen - VA Greater Los Angeles Healthcare SystemDavid A. Talan - Ronald Reagan UCLA Medical CenterEMERGEncy ID Net Study Group
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases, Vol.61(11), pp.1679-1687
- DOI
- 10.1093/cid/civ655
- PMID
- 26240200
- NLM abbreviation
- Clin Infect Dis
- ISSN
- 1058-4838
- eISSN
- 1537-6591
- Publisher
- Oxford Univ Press
- Number of pages
- 9
- Grant note
- U01/CI000353-0 / Centers for Disease Control and Prevention; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA U01CI000353 / NATIONAL CENTER FOR INFECTIOUS DISEASES (NCID); United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA
- Language
- English
- Date published
- 12/01/2015
- Academic Unit
- Emergency Medicine; Internal Medicine
- Record Identifier
- 9984296970102771
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