{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T13:35:17Z","timestamp":1780580117258,"version":"3.54.1"},"reference-count":19,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2016,7,12]],"date-time":"2016-07-12T00:00:00Z","timestamp":1468281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"University of Ioannina Research Committee","award":["22195"],"award-info":[{"award-number":["22195"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Lower leg cellulitis is a diffuse inflammation of the cutaneous connective tissue following invasion of microorganisms and with potential to recur. The causative agent is not routinely identified in clinical practice, and the empirical therapy initiated primarily targets the \u2018conventional\u2019 disease pathogens, <jats:italic>Streptococcus pyogenes<\/jats:italic> and <jats:italic>Staphylococcus aureus<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate at case level, the role of bacterial species isolated from lesional skin in the pathogenesis of community\u2010acquired lower leg cellulitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two sampling methods (superficial swab and biopsy) were applied to isolate bacterial species from 40 patients hospitalized for first (<jats:italic>N<\/jats:italic> = 24 cases) and recurrent (<jats:italic>N<\/jats:italic> = 16 patients) lower leg cellulitis episodes. Subsequently, a clinical\u2010laboratory heuristic algorithm was employed to interpret causality associations of isolated species with disease episodes at case level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 37\/40 cases (92.5%), at least one bacterial species was identified with either sampling method. The number of different species\/specimen isolated from superficial swabs compared to punch biopsies was significantly more (<jats:italic>P<\/jats:italic> &lt; 0.001). A causative agent was identified in 16 cases (40%); it was a \u2018conventional\u2019 pathogen in seven patients and strains belonging to one of six \u2018non\u2010conventional\u2019 pathogens in nine cases. There was no concordance in the spectrum of isolated pathogens with the two sampling methods (kappa\u2010index = 0.028). Another four species may have participated in five patients as co\u2010pathogens in mixed infections. There was also no difference in microbiological disease features between patients with first and recurrent cellulitis episodes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The application of a clinical\u2010laboratory causality algorithm coupled with pooled culture results of more than one sampling methods in patients with lower leg cellulitis is anticipated to permit the identification of responsible bacterial species at case level and offer incentive for therapeutic intervention studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdv.13688","type":"journal-article","created":{"date-parts":[[2016,7,12]],"date-time":"2016-07-12T08:36:40Z","timestamp":1468312600000},"page":"1583-1589","source":"Crossref","is-referenced-by-count":7,"title":["Causality evaluation of bacterial species isolated from patients with community\u2010acquired lower leg cellulitis"],"prefix":"10.1111","volume":"30","author":[{"given":"I.","family":"Chaniotakis","sequence":"first","affiliation":[{"name":"Department of Skin and Venereal Diseases Faculty of Medicine School of Health Sciences University of Ioannina and University Hospital of Ioannina Ioannina Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.G.","family":"Gartzonika","sequence":"additional","affiliation":[{"name":"Department of Microbiology Faculty of Medicine School of Health Sciences University of Ioannina and University Hospital of Ioannina Ioannina Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Gaitanis","sequence":"additional","affiliation":[{"name":"Department of Skin and Venereal Diseases Faculty of Medicine School of Health Sciences University of Ioannina and University Hospital of Ioannina Ioannina Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Levidiotou\u2010Stefanou","sequence":"additional","affiliation":[{"name":"Department of Microbiology Faculty of Medicine School of Health Sciences University of Ioannina and University Hospital of Ioannina Ioannina Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.D.","family":"Bassukas","sequence":"additional","affiliation":[{"name":"Department of Skin and Venereal Diseases Faculty of Medicine School of Health Sciences University of Ioannina and University Hospital of Ioannina Ioannina 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