title: Bacterial Etiology and Risk Factors Associated with Cellulitis and Purulent Skin Abscesses in Military Trainees.
abstract: Military trainees are at high risk for skin and soft-tissue infections (SSTIs). Although Staphylococcus aureus is associated with purulent SSTI, it is unclear to what degree this pathogen causes nonpurulent cellulitis. To inform effective prevention strategies and to provide novel insights into SSTI pathogenesis, we aimed to determine the etiology of SSTI in this population. We conducted a prospective observational study in US Army Infantry trainees with SSTI (cutaneous abscesses and cellulitis) from July 2012 through December 2014. We used standard microbiology, serology, and high-throughput sequencing to determine the etiology of SSTI. Furthermore, we compared purported risk factors as well as anatomic site colonization for S. aureus. Among 201 SSTI cases evaluated for SSTI risk factors, cellulitis was associated with lower extremity blisters (P = 0.01) and abscess was associated with methicillin-resistant S. aureus (MRSA) colonization (P<0.001). Among the 22 tested cellulitis cases that were part of the microbiome analysis, only 1 leading edge aspirate was culturable (Coagulase-negative Staphylococcus). Microbiome evaluation of aspirate specimens demonstrated that Rhodanobacter terrae was the most abundant species (66.8% average abundance), while abscesses were dominated by S. aureus (92.9% average abundance). Although abscesses and cellulitis share the spectrum of clinical SSTI, the bacterial etiologies as determined by current technology appear distinct. Furthermore, the presence of atypical bacteria within cellulitis aspirates may indicate novel mechanisms of cellulitis pathogenesis.
  
  
  BACKGROUND
  NCT01105767.
authors: Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: Ryan C
authors: RC
authors: Johnson
authors: The University of Toledo Medical Center, Toledo, Ohio, United States of America.
authors: Michael W
authors: MW
authors: Ellis
authors: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: Carey D
authors: CD
authors: Schlett
authors: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: Eugene V
authors: EV
authors: Millar
authors: Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: Patrick T
authors: PT
authors: LaBreck
authors: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: Deepika
authors: D
authors: Mor
authors: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: Emad M
authors: EM
authors: Elassal
authors: Martin Army Community Hospital, Fort Benning, Georgia, United States of America.
authors: Jeffrey B
authors: JB
authors: Lanier
authors: The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, United States of America.|Biological Defense Research Directorate, Naval Medical Research Center, Frederick, Fort Detrick, Maryland, United States of America.
authors: Cassie L
authors: CL
authors: Redden
authors: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: Tianyuan
authors: T
authors: Cui
authors: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: Nimfa
authors: N
authors: Teneza-Mora
authors: Infectious Diseases Directorate, Wound Infections Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America.
authors: Danett K
authors: DK
authors: Bishop
authors: Infectious Diseases Directorate, Wound Infections Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America.
authors: Eric R
authors: ER
authors: Hall
authors: The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, United States of America.|Biological Defense Research Directorate, Naval Medical Research Center, Frederick, Fort Detrick, Maryland, United States of America.
authors: Kimberly A
authors: KA
authors: Bishop-Lilly
authors: Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.|Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
authors: D Scott
authors: http://orcid.org/0000-0002-2114-2951
authors: DS
authors: Merrell
mesh_terms: D000038:Abscess / Q000382:microbiology*; D000293:Adolescent; D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification / Q000378:metabolism; D018407:Bacterial Physiological Phenomena; D002481:Cellulitis / Q000382:microbiology*; D004269:DNA, Bacterial / Q000737:chemistry / Q000302:isolation & purification / Q000378:metabolism; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D064307:Microbiota; D008889:Military Personnel; D011446:Prospective Studies; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D018461:Soft Tissue Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial