Assessment of the risk factors of recurrent lower extremity cellulits and the effect of clinical and laboratory findings on treatment response

Abstract

Aim: To determine the risk factors of patients followed with recurrent lower extremity cellulitis and to find out the effect of clinical and laboratory findings on treatment response.Material and Method: This retrospective study was conducted between September 2011 and June 2016 at Infectious Disease clinic of Istanbul Medeniyet University Education and Research Hospital and all hospitalized patients diagnosed as lower extremity cellulitis, aged between 18-91, were involved. Data of all patients was determined by searching patients files and epicrisis. Demographic features, accompanying disease, predisposing factors, last cellulitis attack and its features, patients symptoms at hospitalization day, physical examination findings, laboratory values, given antibiotics and control laboratory values at 72 h were investigated.Results: Totally 93 patients with a diagnosis of lower extremity cellulitis, 40 (43%) of whom had recurrent cellulitis were included in the study, Patients with a history of recurrent cellulitis compared with patients with first attack. Patients having tinea pedis (p=0.038) and diagnosed as coronary artery disease (0.015) were found statistically significant for recurrent cellulitis. Patients white blood cell (WBC), c-reactive protein (CRP) value at hospitalization day and control laboratory values at 72 h were compared and no statistically significant data obtained. Treatment change has done after 48-72 hours on 28 of patients whom receiving antibiotherapy with the idea of treatment failure. Between patients considering unresponsiveness to antibiotic therapy and undergone treatment change, statistically significant differences were detected for WBC (p=0.016) and CRP (0.024) value at the day of hospitalization, control WBC (0.01) and CRP (0.001) value at 72 h. Similarly, statistically significant results for the patients had severe pain in lower extremity at the day of hospitalization were obtained (p=0.019).Conclusion: Patients having tinea pedis and accompanying coronary artery disease are more probable to new cellulitis attack whose had a history of recurrent lower extremity cellulitis. The risk would be more through nonresponder patients whom WBC and CRP value were high at hospitalization day and the continuation of high WBC and CRP values at 72 h were detected. In patients undergone treatment change, statistically significant differences were detected between patients have severe pain in lower extremity at the day of hospitalization and patients not.