Abstract
BackgroundCellulitis is a frequent cause of hospital admission of adult patients. Increasing prevalence of multiresistant microorganisms, comorbidities, predisposing factors and medical and surgical therapies might affect cellulitis response and recurrence rate.MethodsProspective and observational study of 606 adult patients with cellulitis admitted to several Spanish hospitals. Comorbidities, microbiological, clinical, diagnostic, treatment (surgical and antibiotic) data were analyzed according to the cellulitis response. Good response implied cure. Poor response implied failure to cure or initial cure but relapse within 30 days of hospital discharge.ResultsMean age was 63.3 years and 51.8% were men. Poor responses were significantly associated with age, previous episodes of cellulitis, prior wounds and skin lesions, venous insufficiency, lymphedema, immunosuppression and lower limbs involvement. No differences in ESR or CRP blood levels, leukocyte counts, pus or blood cultures positivity or microbiological or imaging aspects were observed in those with good or poor responses. Regarding antimicrobials, no differences in previous exposition before hospital admission, treatment with single or more than one antibiotic, antibiotic switch, days on antimicrobials or surgical treatment were observed regarding good or poor cellulitis response. Prior episodes of cellulitis (P = 0.0001), venous insufficiency (P = 0.004), immunosuppression (P = 0.03), and development of sepsis (P = 0.05) were associated with poor treatment responses, and non-surgical trauma (P = 0.015) with good responses, in the multivariate analysis.ConclusionsPrior episodes of cellulitis, non-surgical trauma, venous insufficiency, sepsis and immunosuppression were independently associated with treatment response to cellulitis, but not the causative microorganism, the number of antimicrobials administered or its duration.
Highlights
Cellulitis [a common type of skin and soft tissue infection] is a frequent bacterial infection of the skin and subcutaneous tissues, whose incidence is rising, and that results in substantial economic and healthcare burdens [1,2,3,4,5,6,7]
Non-surgical trauma, venous insufficiency, sepsis and immunosuppression were independently associated with treatment response to cellulitis, but not the causative microorganism, the number of antimicrobials administered or its duration
The causative microorganism is not identified in most cases of cellulitis, but Streptococcus pyogenes, other streptococci and Staphylococcus aureus account for about three-fourths of those cases in which an agent is recovered, the relative proportion may differ depending on the type cellulitis and the individual characteristics of the patients [3,4,5,6,7, 9, 10]
Summary
Cellulitis [a common type of skin and soft tissue infection] is a frequent bacterial infection of the skin and subcutaneous tissues, whose incidence is rising, and that results in substantial economic and healthcare burdens [1,2,3,4,5,6,7]. Mild cellulitis can be managed in the ambulatory setting by family doctors, more serious cases represent a common and progressively increasing cause of hospital admissions in developed countries, among the elderly and individuals with predisposing factors or comorbidities [1,2,3,4]. Healthcare costs are increased because of frequent hospital readmissions due to the high recurrence rate of cellulitis, which is favored by diverse local and systemic factors [3,4,5]. Increasing prevalence of multiresistant microorganisms, comorbidities, predisposing factors and medical and surgical therapies might affect cellulitis response and recurrence rate
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