Editor's Correspondence |

Do Not Abandon Cultures

James R. Johnson, MD
Arch Intern Med. 2011;171(12):1128. doi:10.1001/archinternmed.2011.260.
Text Size: A A A
Published online


Jenkins et al1 are to be commended on achieving significant reductions in the duration of antimicrobial therapy and decreased use of broad spectrum agents among patients hospitalized for uncomplicated skin infections, through the use of a management algorithm. However, as noted in the accompanying commentary with respect to the authors' treatment algorithm, more emphasis may be warranted on the “uncomplicated” study inclusion criterion.2 In particular, the authors' advocacy for avoiding (presumably unnecessary) microbiological tests should not be applied inappropriately to other populations with skin infections, in whom such tests, particularly wound cultures, can be extremely helpful in selecting step-down oral therapy. For example, group B streptococci, a not uncommon cause of foot infections among patients with diabetes mellitus or peripheral vascular disease, are usually resistant to tetracyclines, including doxycycline. Likewise, group A streptococci are unreliably responsive to trimethoprim-sulfamethoxazole. Similarly, many methicillin-resistant staphylococci are clindamycin resistant, and some (albeit a small minority) are resistant to tetracyclines and/or trimethoprim-sulfamethoxazole. Moreover, diabetic foot infections, particularly more severe episodes, may involve gram-negative bacilli, which have highly unpredictable susceptibility patterns. Consequently, swab cultures from infected skin ulcers (notwithstanding their nonspecificity) and cultures of abscess pus can yield clinically important information in the appropriate context. The favorable emphasis Jenkins et al1 give in the abstract to the observed “significant decrease in use of microbiological cultures” (which refers primarily to blood cultures, not wound cultures) might lead the casual reader to conclude, one hopes erroneously, that these authors believe wound (or pus) cultures should be avoided generally in patients with cellulitis or skin abscesses. On the contrary, in this era of increasing antimicrobial resistance, wider use of such cultures probably should be encouraged, particularly with compromised hosts, to allow just the sort of targeted therapy Jenkins et al1 appropriately support.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics

Users' Guides to the Medical Literature
Peripheral Arterial Disease or Peripheral Vascular Insufficiency

The Rational Clinical Examination
Make the Diagnosis: Peripheral Arterial Disease