PCR offers no advantage over culture for microbiologic diagnosis in cellulitis

K. E. Johnson, Dmitry Kiyatkin, A. T. An, S. Riedel, J. Melendez, Jonathan Mark Zenilman

Research output: Contribution to journalArticle

Abstract

Purpose Most cases of cellulitis are traditionally attributed to β-hemolytic Streptococcus and Staphylococcus species, although in most cases, no organism is identified. Development of PCR using the conserved bacterial 16 S rRNA DNA permits identification of bacteria independent of conventional culture approaches and prior use of antibiotics. Methods We used PCR-based techniques to identify cellulitis etiology using aspirate samples from affected skin. Saline was infiltrated and aspirated at the site of greatest erythema or at the cellulitic border. Samples were tested for 16 S rRNA DNA, and organism-specific probes used to identify bacteria commonly seen in skin infections. Results Aspirates from 32 patients were studied, and 16 S rRNA DNA was detected in nine of these patient samples (28.1 %). Bacterial species were identified by PCR methods in six of these nine samples (66.6 %), with S. aureus and methicillin-resistant S. aureus (MRSA) identified in four and two, respectively, of these samples. Of the patients with positive aspirate bacterial cultures (3/9, 33.3 %), S. aureus and coagulase-negative Staphylococcus (CoNS) were present on cultures of two of the three (both 66.6 %) positive samples. Only in one of the three positive bacterial cultures did the PCR method detect the same organism as was detected by culture. Among patients with positive provider-collected clinical cultures, MRSA was the predominant organism (11/18, 61.1 %) and when present, it was found as the sole organism. Where S. aureus or Streptococcus species were detected by molecular methods, clinical cultures yielded a positive result as well. Conclusions PCR-based techniques do not appear to be more sensitive than aspirate cultures for the detection of pathogens in cellulitis.

Original languageEnglish (US)
Pages (from-to)537-541
Number of pages5
JournalInfection
Volume40
Issue number5
DOIs
StatePublished - Oct 2012

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Cellulitis
Polymerase Chain Reaction
Methicillin Resistance
Streptococcus
Staphylococcus
DNA
Bacteria
Skin
Coagulase
Erythema
Anti-Bacterial Agents
Infection

Keywords

  • 16S rRNA
  • Cellulitis
  • Eukaryotic PCR
  • Skin and skin structure infection
  • Skin and soft tissue infection

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

PCR offers no advantage over culture for microbiologic diagnosis in cellulitis. / Johnson, K. E.; Kiyatkin, Dmitry; An, A. T.; Riedel, S.; Melendez, J.; Zenilman, Jonathan Mark.

In: Infection, Vol. 40, No. 5, 10.2012, p. 537-541.

Research output: Contribution to journalArticle

Johnson, K. E. ; Kiyatkin, Dmitry ; An, A. T. ; Riedel, S. ; Melendez, J. ; Zenilman, Jonathan Mark. / PCR offers no advantage over culture for microbiologic diagnosis in cellulitis. In: Infection. 2012 ; Vol. 40, No. 5. pp. 537-541.
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abstract = "Purpose Most cases of cellulitis are traditionally attributed to β-hemolytic Streptococcus and Staphylococcus species, although in most cases, no organism is identified. Development of PCR using the conserved bacterial 16 S rRNA DNA permits identification of bacteria independent of conventional culture approaches and prior use of antibiotics. Methods We used PCR-based techniques to identify cellulitis etiology using aspirate samples from affected skin. Saline was infiltrated and aspirated at the site of greatest erythema or at the cellulitic border. Samples were tested for 16 S rRNA DNA, and organism-specific probes used to identify bacteria commonly seen in skin infections. Results Aspirates from 32 patients were studied, and 16 S rRNA DNA was detected in nine of these patient samples (28.1 {\%}). Bacterial species were identified by PCR methods in six of these nine samples (66.6 {\%}), with S. aureus and methicillin-resistant S. aureus (MRSA) identified in four and two, respectively, of these samples. Of the patients with positive aspirate bacterial cultures (3/9, 33.3 {\%}), S. aureus and coagulase-negative Staphylococcus (CoNS) were present on cultures of two of the three (both 66.6 {\%}) positive samples. Only in one of the three positive bacterial cultures did the PCR method detect the same organism as was detected by culture. Among patients with positive provider-collected clinical cultures, MRSA was the predominant organism (11/18, 61.1 {\%}) and when present, it was found as the sole organism. Where S. aureus or Streptococcus species were detected by molecular methods, clinical cultures yielded a positive result as well. Conclusions PCR-based techniques do not appear to be more sensitive than aspirate cultures for the detection of pathogens in cellulitis.",
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AU - Melendez, J.

AU - Zenilman, Jonathan Mark

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N2 - Purpose Most cases of cellulitis are traditionally attributed to β-hemolytic Streptococcus and Staphylococcus species, although in most cases, no organism is identified. Development of PCR using the conserved bacterial 16 S rRNA DNA permits identification of bacteria independent of conventional culture approaches and prior use of antibiotics. Methods We used PCR-based techniques to identify cellulitis etiology using aspirate samples from affected skin. Saline was infiltrated and aspirated at the site of greatest erythema or at the cellulitic border. Samples were tested for 16 S rRNA DNA, and organism-specific probes used to identify bacteria commonly seen in skin infections. Results Aspirates from 32 patients were studied, and 16 S rRNA DNA was detected in nine of these patient samples (28.1 %). Bacterial species were identified by PCR methods in six of these nine samples (66.6 %), with S. aureus and methicillin-resistant S. aureus (MRSA) identified in four and two, respectively, of these samples. Of the patients with positive aspirate bacterial cultures (3/9, 33.3 %), S. aureus and coagulase-negative Staphylococcus (CoNS) were present on cultures of two of the three (both 66.6 %) positive samples. Only in one of the three positive bacterial cultures did the PCR method detect the same organism as was detected by culture. Among patients with positive provider-collected clinical cultures, MRSA was the predominant organism (11/18, 61.1 %) and when present, it was found as the sole organism. Where S. aureus or Streptococcus species were detected by molecular methods, clinical cultures yielded a positive result as well. Conclusions PCR-based techniques do not appear to be more sensitive than aspirate cultures for the detection of pathogens in cellulitis.

AB - Purpose Most cases of cellulitis are traditionally attributed to β-hemolytic Streptococcus and Staphylococcus species, although in most cases, no organism is identified. Development of PCR using the conserved bacterial 16 S rRNA DNA permits identification of bacteria independent of conventional culture approaches and prior use of antibiotics. Methods We used PCR-based techniques to identify cellulitis etiology using aspirate samples from affected skin. Saline was infiltrated and aspirated at the site of greatest erythema or at the cellulitic border. Samples were tested for 16 S rRNA DNA, and organism-specific probes used to identify bacteria commonly seen in skin infections. Results Aspirates from 32 patients were studied, and 16 S rRNA DNA was detected in nine of these patient samples (28.1 %). Bacterial species were identified by PCR methods in six of these nine samples (66.6 %), with S. aureus and methicillin-resistant S. aureus (MRSA) identified in four and two, respectively, of these samples. Of the patients with positive aspirate bacterial cultures (3/9, 33.3 %), S. aureus and coagulase-negative Staphylococcus (CoNS) were present on cultures of two of the three (both 66.6 %) positive samples. Only in one of the three positive bacterial cultures did the PCR method detect the same organism as was detected by culture. Among patients with positive provider-collected clinical cultures, MRSA was the predominant organism (11/18, 61.1 %) and when present, it was found as the sole organism. Where S. aureus or Streptococcus species were detected by molecular methods, clinical cultures yielded a positive result as well. Conclusions PCR-based techniques do not appear to be more sensitive than aspirate cultures for the detection of pathogens in cellulitis.

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KW - Eukaryotic PCR

KW - Skin and skin structure infection

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