title: A systematic review of bacteremias in cellulitis and erysipelas.
abstract: OBJECTIVE
  Because of the difficulty of obtaining bacterial cultures from patients with cellulitis and erysipelas, the microbiology of these common infections remains incompletely defined. Given the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) over the past decade the proportion of infections due to S. aureus has become particularly relevant.
  
  
  METHODS
  OVID was used to search Medline using the focused subject headings "cellulitis", "erysipelas" and "soft tissue infections". All references that involved adult patients with cellulitis or erysipelas and reported associated bacteremias and specific pathogens were included in the review.
  
  
  RESULTS
  For erysipelas, 4.6% of 607 patients had positive blood cultures, of which 46% were Streptococcus pyogenes, 29% were other β-hemolytic streptococci, 14% were Staphylococcus aureus, and 11% were Gram-negative organisms. For cellulitis, 7.9% of 1578 patients had positive blood cultures of which 19% were Streptococcus pyogenes, 38% were other β-hemolytic streptococci, 14% were Staphylococcus aureus, and 28% were Gram-negative organisms.
  
  
  CONCLUSIONS
  Although the strength of our conclusions are somewhat limited by the heterogeneity of included cases, our results support the traditional view that cellulitis and erysipelas are primarily due to streptococcal species, with a smaller proportion due to S. aureus. Our results also argue against the current distinction between cellulitis and erysipelas in terms of the relative proportion of infections due to S. aureus.
authors.affiliation: Department of Internal Medicine and VA Connecticut Health Care System, Yale School of Medicine, West Haven CT 06516, USA. craig.gunderson@va.gov
authors.forename: Craig G
authors.initials: CG
authors.lastname: Gunderson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Martinello
mesh_terms: D016470:Bacteremia / Q000382:microbiology; D002481:Cellulitis / Q000382:microbiology*; D004886:Erysipelas / Q000382:microbiology*; D006801:Humans; D013203:Staphylococcal Infections / Q000382:microbiology; D013211:Staphylococcus aureus / Q000472:pathogenicity; D013290:Streptococcal Infections / Q000382:microbiology; D013291:Streptococcus / Q000472:pathogenicity