Culture-and nonculture-based antibiotics for complicated soft tissue infections are comparable

BACKGROUND
Data collected in 2010 from Cipto Mangunkusumo Hospital indicate that
complicated skin and soft tissue infections accounted for more than 10% of
cases. Etiological diagnoses are based on the findings on bacterial culture and
thus evaluation of the effectiveness of bacterial culture becomes a necessity.
The purpose of this study was to evaluate the operational effectiveness of
bacterial culture for etiological diagnosis of complicated skin and soft tissue
infections.
METHODS
This was a historical cohort study using secondary data of patients with
complicated skin and soft tissue infections admitted for hospitalization to Cipto
Mangunkusumo Hospital, Jakarta from July 2011 to July 2012. The 90 subjects
meeting the inclusion and exclusion criteria were divided into 2 groups of 45
patients each. Group 1 comprised patients who received initial antibiotic therapy
according to cultural results, while the patients in group 2 received initial antibiotic
therapy without reference to cultural results. Successful diagnostic culture was
assessed by the absence of therapeutic failure. Therapeutic failure was
determined using 3 parameters that had to be fulfilled, viz. absence of antibiotic
escalation, repeat operations, and clinical deterioration. The latter parameter
was assessed by clinical judgement of the attending physician.
RESULTS
After controlling for confounding variables (age, severity of infection,
comorbidity), there was no statistical difference in therapeutic success between
culture-based and non-culture based initial antibiotic therapies (OR=0.45,
p=0.085).
CONCLUSION
This study demonstrates the ineffectiveness of bacterial culture as a diagnostic
criterion for appropriate antibiotic therapy of complicated skin and soft tissue
infections.