Bacterial Etiology and Risk Factors Associated with Cellulitis and Purulent Skin Abscesses in Military Trainees
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...
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| Veröffentlicht in: | PloS one 2016-10, Vol.11 (10), p.e0165491-e0165491 |
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| creator | Johnson, Ryan C Ellis, Michael W Schlett, Carey D Millar, Eugene V LaBreck, Patrick T Mor, Deepika Elassal, Emad M Lanier, Jeffrey B Redden, Cassie L Cui, Tianyuan Teneza-Mora, Nimfa Bishop, Danett K Hall, Eric R Bishop-Lilly, Kimberly A Merrell, D Scott |
| description | 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 |
| doi_str_mv | 10.1371/journal.pone.0165491 |
| format | Article |
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NCT01105767.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0165491</identifier><identifier>PMID: 27780238</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abscess ; Abscess - microbiology ; Abscesses ; Abundance ; Adolescent ; Antibiotics ; Bacteria ; Bacteria - genetics ; Bacteria - isolation & purification ; Bacteria - metabolism ; Bacterial Physiological Phenomena ; Biology and life sciences ; Biometrics ; Biopsy ; Blistering ; Blisters ; Cellulitis ; Cellulitis - microbiology ; Clinical trials ; Coagulase ; Colonization ; Development and progression ; Disease prevention ; DNA, Bacterial - chemistry ; DNA, Bacterial - isolation & purification ; DNA, Bacterial - metabolism ; Drug resistance ; Epidemiology ; Etiology ; Etiology (Medicine) ; Health aspects ; Health risks ; Health sciences ; Humans ; Immunology ; Infectious diseases ; Male ; Medical research ; Medicine and Health Sciences ; Methicillin ; Methicillin-Resistant Staphylococcus aureus - genetics ; Methicillin-Resistant Staphylococcus aureus - isolation & purification ; Methicillin-Resistant Staphylococcus aureus - physiology ; Microbiology ; Microbiomes ; Microbiota ; Military ; Military aspects ; Military medicine ; Military Personnel ; Next-generation sequencing ; Pathogenesis ; Preventive medicine ; Prospective Studies ; Research and Analysis Methods ; Risk analysis ; Risk Factors ; Sequence Analysis, DNA ; Serology ; Skin ; Soft Tissue Infections - microbiology ; Staphylococcus aureus ; Staphylococcus aureus - genetics ; Staphylococcus aureus - isolation & purification ; Staphylococcus aureus - physiology ; Staphylococcus aureus infections ; Staphylococcus infections ; Streptococcus infections ; Young Adult</subject><ispartof>PloS one, 2016-10, Vol.11 (10), p.e0165491-e0165491</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-aab4705d81d2fee49a3a485088bc6b61785587003b9c0b2bf4c3483ffdb36d3c3</citedby><cites>FETCH-LOGICAL-c725t-aab4705d81d2fee49a3a485088bc6b61785587003b9c0b2bf4c3483ffdb36d3c3</cites><orcidid>0000-0002-2114-2951</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079656/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079656/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53770,53772,79347,79348</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27780238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Seleem, Mohamed N.</contributor><creatorcontrib>Johnson, Ryan C</creatorcontrib><creatorcontrib>Ellis, Michael W</creatorcontrib><creatorcontrib>Schlett, Carey D</creatorcontrib><creatorcontrib>Millar, Eugene V</creatorcontrib><creatorcontrib>LaBreck, Patrick T</creatorcontrib><creatorcontrib>Mor, Deepika</creatorcontrib><creatorcontrib>Elassal, Emad M</creatorcontrib><creatorcontrib>Lanier, Jeffrey B</creatorcontrib><creatorcontrib>Redden, Cassie L</creatorcontrib><creatorcontrib>Cui, Tianyuan</creatorcontrib><creatorcontrib>Teneza-Mora, Nimfa</creatorcontrib><creatorcontrib>Bishop, Danett K</creatorcontrib><creatorcontrib>Hall, Eric R</creatorcontrib><creatorcontrib>Bishop-Lilly, Kimberly A</creatorcontrib><creatorcontrib>Merrell, D Scott</creatorcontrib><title>Bacterial Etiology and Risk Factors Associated with Cellulitis and Purulent Skin Abscesses in Military Trainees</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
NCT01105767.</description><subject>Abscess</subject><subject>Abscess - microbiology</subject><subject>Abscesses</subject><subject>Abundance</subject><subject>Adolescent</subject><subject>Antibiotics</subject><subject>Bacteria</subject><subject>Bacteria - genetics</subject><subject>Bacteria - isolation & purification</subject><subject>Bacteria - metabolism</subject><subject>Bacterial Physiological Phenomena</subject><subject>Biology and life sciences</subject><subject>Biometrics</subject><subject>Biopsy</subject><subject>Blistering</subject><subject>Blisters</subject><subject>Cellulitis</subject><subject>Cellulitis - microbiology</subject><subject>Clinical trials</subject><subject>Coagulase</subject><subject>Colonization</subject><subject>Development and progression</subject><subject>Disease prevention</subject><subject>DNA, Bacterial - chemistry</subject><subject>DNA, Bacterial - isolation & purification</subject><subject>DNA, Bacterial - metabolism</subject><subject>Drug resistance</subject><subject>Epidemiology</subject><subject>Etiology</subject><subject>Etiology (Medicine)</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Health sciences</subject><subject>Humans</subject><subject>Immunology</subject><subject>Infectious diseases</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Methicillin</subject><subject>Methicillin-Resistant Staphylococcus aureus - genetics</subject><subject>Methicillin-Resistant Staphylococcus aureus - isolation & purification</subject><subject>Methicillin-Resistant Staphylococcus aureus - physiology</subject><subject>Microbiology</subject><subject>Microbiomes</subject><subject>Microbiota</subject><subject>Military</subject><subject>Military aspects</subject><subject>Military medicine</subject><subject>Military Personnel</subject><subject>Next-generation sequencing</subject><subject>Pathogenesis</subject><subject>Preventive medicine</subject><subject>Prospective Studies</subject><subject>Research and Analysis Methods</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Sequence Analysis, DNA</subject><subject>Serology</subject><subject>Skin</subject><subject>Soft Tissue Infections - microbiology</subject><subject>Staphylococcus aureus</subject><subject>Staphylococcus aureus - genetics</subject><subject>Staphylococcus aureus - isolation & purification</subject><subject>Staphylococcus aureus - physiology</subject><subject>Staphylococcus aureus infections</subject><subject>Staphylococcus infections</subject><subject>Streptococcus infections</subject><subject>Young 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Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest Biological Science Journals</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Johnson, Ryan C</au><au>Ellis, Michael W</au><au>Schlett, Carey D</au><au>Millar, Eugene V</au><au>LaBreck, Patrick T</au><au>Mor, Deepika</au><au>Elassal, Emad M</au><au>Lanier, Jeffrey B</au><au>Redden, Cassie L</au><au>Cui, Tianyuan</au><au>Teneza-Mora, Nimfa</au><au>Bishop, Danett K</au><au>Hall, Eric R</au><au>Bishop-Lilly, Kimberly A</au><au>Merrell, D Scott</au><au>Seleem, Mohamed N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bacterial Etiology and Risk Factors Associated with Cellulitis and Purulent Skin Abscesses in Military Trainees</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-10-25</date><risdate>2016</risdate><volume>11</volume><issue>10</issue><spage>e0165491</spage><epage>e0165491</epage><pages>e0165491-e0165491</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><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.
NCT01105767.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>27780238</pmid><doi>10.1371/journal.pone.0165491</doi><tpages>e0165491</tpages><orcidid>https://orcid.org/0000-0002-2114-2951</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2016-10, Vol.11 (10), p.e0165491-e0165491 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1832219030 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Abscess Abscess - microbiology Abscesses Abundance Adolescent Antibiotics Bacteria Bacteria - genetics Bacteria - isolation & purification Bacteria - metabolism Bacterial Physiological Phenomena Biology and life sciences Biometrics Biopsy Blistering Blisters Cellulitis Cellulitis - microbiology Clinical trials Coagulase Colonization Development and progression Disease prevention DNA, Bacterial - chemistry DNA, Bacterial - isolation & purification DNA, Bacterial - metabolism Drug resistance Epidemiology Etiology Etiology (Medicine) Health aspects Health risks Health sciences Humans Immunology Infectious diseases Male Medical research Medicine and Health Sciences Methicillin Methicillin-Resistant Staphylococcus aureus - genetics Methicillin-Resistant Staphylococcus aureus - isolation & purification Methicillin-Resistant Staphylococcus aureus - physiology Microbiology Microbiomes Microbiota Military Military aspects Military medicine Military Personnel Next-generation sequencing Pathogenesis Preventive medicine Prospective Studies Research and Analysis Methods Risk analysis Risk Factors Sequence Analysis, DNA Serology Skin Soft Tissue Infections - microbiology Staphylococcus aureus Staphylococcus aureus - genetics Staphylococcus aureus - isolation & purification Staphylococcus aureus - physiology Staphylococcus aureus infections Staphylococcus infections Streptococcus infections Young Adult |
| title | Bacterial Etiology and Risk Factors Associated with Cellulitis and Purulent Skin Abscesses in Military Trainees |
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