title: Skin and soft tissue infections: experience over a five-year period and clinical usefulness of ultrasonography-guided gun biopsy-based culture.
abstract: BACKGROUND
  Skin and soft tissue infections (SSTIs) are common clinical diseases, but only a few reports of microbiological data on SSTIs in Korea have been published. In practice, specimens are rarely obtained from infected lesions unless there is visible pus or an abscess pocket. However, identification of the causative pathogen is important, because of emerging drug resistance and the increase in immunocompromised hosts.
  
  
  METHODS
  The medical records of 760 adult cases of community-acquired SSTIs (CA-SSTIs) from September 2003 to August 2008 were reviewed retrospectively. We analyzed epidemio-clinical features and microbiological distributions of CA-SSTIs and evaluated the positive culture rate of several diagnostic methods, including swab, tissue biopsy, blind needle aspiration, ultrasonography (US)-guided needle aspiration, and US-guided gun biopsy.
  
  
  RESULTS
  Most CA-SSTIs (76.1%) occurred in previously healthy persons without underlying diseases. Re-infections were identified in 76 (10%) patients and cirrhosis was an independent risk factor for re-infection (odds ratio 3.64, 95% confidence interval 1.36-9.76). The most commonly identified pathogen was methicillin-susceptible Staphylococcus aureus, and 3(rd)-generation cephalosporins were the most commonly used empirical antibiotics (47.9%). US-guided needle aspiration had a high positive culture rate of 73.9% and the positive culture rate of US-guided gun biopsy was 17.5%.
  
  
  CONCLUSIONS
  Considering the microbiological distribution of CA-SSTIs in Korea, penicillinase-stable penicillin or a 1(st)-generation cephalosporin should be adequate for initial antibiotic treatment. US-guided needle aspiration was a good technique for the identification of causative pathogens, and additive productivity is expected with US-guided gun biopsy culture from lesions without fluid collection.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Guro-gu, Seoul 152-703, Korea.
authors.forename: Ji Yun
authors.initials: JY
authors.lastname: Noh
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Cheong
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Song
authors.forename: Suk-Joo
authors.initials: SJ
authors.lastname: Hong
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Myung
authors.forename: Won Suk
authors.initials: WS
authors.lastname: Choi
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Jo
authors.forename: Jung Yeon
authors.initials: JY
authors.lastname: Heo
authors.forename: Woo Joo
authors.initials: WJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000145:classification / Q000254:growth & development / Q000302:isolation & purification*; D001706:Biopsy / Q000379:methods*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000382:microbiology*; D014463:Ultrasonography / Q000379:methods*