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Eur J Clin Microbiol Infect Dis. 2019 Mar;38(3):545-552. doi: 10.1007/s10096-018-03456-0. Epub 2019 Jan 24.

Impact of health care-associated community-onset cellulitis in Korea: a multicenter study.

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Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea.
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea.
Department of Internal Medicine, Ulsan University Hospital, Ulsan, South Korea.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea.
Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea.
Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea.
Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea.
Department of Internal Medicine, Gangneung Asan Hospital, Gangneung, South Korea.
Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, South Korea.
Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Juhwa-ro 170, Ilsanseo-gu, Goyang-si, Gyeonggi-do, 10380, South Korea.


We conducted a multicenter study to determine the clinical and microbiological characteristics of health care-associated (HCA) cellulitis in Korea. We retrospectively reviewed the medical records of patients who had been diagnosed with community-onset cellulitis. Of the 2208 cellulitis patients, 232 (10.5%) had HCA cellulitis, 1243 (56.3%) patients were hospitalized, and 15 (0.7%) died in hospital. Compared with community-acquired (CA) cellulitis, patients with HCA cellulitis were older and more frequently presented with comorbidity and septic shock. A total of 355 microorganisms were isolated from 314 patients (14.2%). Staphylococcus aureus (134 isolates) was the most common organism, followed by Streptococcus spp. (86 isolates) and Gram-negative fermenters (58 isolates). Methicillin-resistant S. aureus (MRSA) accounted for 29.1% (39/134) of S. aureus infections. None of the Gram-negative fermenters were resistant to carbapenem. The antibiotic susceptibility pattern of isolated microorganisms was not different between HCA and CA cellulitis. In patients with HCA cellulitis, S. aureus (11.2% [26/232] vs. 5.5% [108/1976], p = 0.001), including MRSA (4.3% [10/232] vs. 1.5% [29/1976], p = 0.003) and Gram-negative fermenters (6.0% [14/232] vs. 2.3% [44/1976], p = 0.002), were more common causative organisms than in CA-cellulitis patients. Age ≥ 65 years, septic shock, and HCA infection were statistically significant factors associated with in-hospital mortality.


Cellulitis; Health care–associated infection; Staphylococcus aureus


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