Erysipelas, a large retrospective study of aetiology and clinical presentation

Abstract

Background: Erysipelas is a common and severe infection where the aetiology and optimal management is not well-studied. Here, we investigate the clinical features, bacteriological aetiology, and treatment of erysipelas.

Methods: Episodes of erysipelas in a seven-years period in our institution were studied retrospectively using a pre-specified protocol and is presented with descriptive and comparative statistics.

Results: 1142 episodes of erysipelas were identified in 981 patients. Patients had a median age of 61 years, 59 % were male, a majority had underlying diseases or predisposing conditions, and the leg was most often affected. Wound cultures were taken in 343 episodes and 56 grew group A streptococci (GAS), 53 grew group G streptococci (GGS), 11 grew group C streptococci (GCS), and 153 grew Staphylococcus aureus. Blood cultures were drawn in 49 % of episodes and 50 cultures were positive with GGS as the most common finding (21 cultures) followed by GAS in 13, group B streptococci in 5, S. aureus in 4, and GCS in 3 cultures. In 45 % of episodes, patients received antibiotics with activity against S. aureus.

Conclusions: GGS is the most common streptococcus isolated in erysipelas and the role of S. aureus in erysipelas remains elusive.

Fig. 1

Number of skin swabs and wound cultures positive for different possible pathogens is given. The black part of the bar represents a monoculture of the respective pathogen whereas the grey part of the bar represents culture where more than one bacterial species was identified

Fig. 2

Number of blood cultures positive for different bacterial species. For SDSE, the black part of the bar represents GGS and the grey part represents GCS. For S. pyogenes, the black part of the bar represents monocultures whereas the grey part represents a culture which also grew P. aeruginosa and coagulase negative staphylococci