title: Bacteraemia in patients with hidradenitis suppurativa undergoing carbon dioxide laser surgery: detection and quantification of bacteria by lysis-filtration.
abstract: BACKGROUND
  Hidradenitis suppurativa (HS) is a cicatrising and persistent disease of apocrine gland-bearing areas in adults. The severity of this condition varies from a few suppurating lesions to widespread, disabling disease. The aetiology is obscure, but suggested contributory factors include a genetic predisposition, comedones occluding the pilosebaceous apparatus, bacterial infections, and hormonal factors. Treatment consists mainly of surgery, while medical therapies serve principally as adjunct therapy.
  
  
  OBJECTIVE
  The aim of the study was to determine the number and type of bacteria circulating in the bloodstream in patients with HS undergoing surgical treatment with a carbon dioxide laser stripping-secondary intention technique.
  
  
  METHODS
  Twenty-one patients (20 females and 1 male, mean age 36, range 20-55 years) were included in the study. One blood sample (8.3 ml) was taken before surgery, one during the operation and the last one 10 min after surgery. Five healthy persons (all females, mean age 36, range 23-48 years) not undergoing any operation were used as the controls. The blood was cultured by a lysis-filtration technique which had been shown to be very sensitive. Since the filter catches the microorganisms and colonies are formed during culturing, the number of bacteria in the samples is easily determined.
  
  
  RESULTS
  In 6 patients, all samples were negative, which indicates that the method of surgery itself caused no spread of bacteria from the lesions. Bacterial growth in the first blood sample was found in 9 patients, from the second sample in 10 and from the third one in 6. In 1 patient, bacteria were detected in three samples. At least 12 bacterial species were identified. The dominating bacteria were coagulase-negative staphylococci of which most were subtyped as Staphylococcus warneri. Among the anaerobic microorganisms, Propionibacterium acnes and P.granulosum were the most frequently isolated bacteria. The bacterial findings in the blood samples accord well with the results from a previous study in which cultures were taken from the deep parts of the HS lesions. In the 5 controls, no microbial growth was detected.
  
  
  CONCLUSIONS
  The carbon dioxide laser stripping technique caused no additional spread of bacteria into the bloodstream. The evaluation of cultures containing microorganisms from normal skin flora is controversial. Since the bacteria encountered in this study are in close agreement with the findings in cultures from the deeper parts of HS lesions they seem to be relevant. The growth of bacteria in the first blood sample taken before surgery may indicate that some of these patients have bacteria continuously circulating in their blood.
authors.affiliation: Section of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden. karin.sartorius@karolinska.se
authors.forename: Karin
authors.initials: K
authors.lastname: Sartorius
authors.forename: Jan
authors.initials: J
authors.lastname: Lapins
authors.forename: Shah
authors.initials: S
authors.lastname: Jalal
authors.forename: Lennart
authors.initials: L
authors.lastname: Emtestam
authors.forename: Maria
authors.initials: M
authors.lastname: Hedberg
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D001431:Bacteriological Techniques; D002245:Carbon Dioxide; D015169:Colony Count, Microbial; D005260:Female; D005374:Filtration / Q000379:methods; D017497:Hidradenitis Suppurativa / Q000097:blood / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011424:Propionibacterium / Q000302:isolation & purification; D011425:Propionibacterium acnes / Q000302:isolation & purification; D013210:Staphylococcus / Q000145:classification / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification
chemical_list: D002245:Carbon Dioxide