Cellulitis in older people over 75 years - are there differences?

Manoj Kumar,Vincent Jiu Jong Ngian,Clarence Yeong,Bin Soo Ong,Huong Van Nguyen,Caitlin Keighley

doi:10.1016/j.amsu.2019.11.012

Manoj Kumar, Vincent Jiu Jong Ngian + Show 4 more

Open Access

https://doi.org/10.1016/j.amsu.2019.11.012

Copy DOI

Abstract

AimTo examine differences in risk factors, clinical features and outcomes of cellulitis between those 75 + years and those <75 years admitted to a metropolitan hospital.MethodsA prospective study of patients with limb cellulitis requiring intravenous antibiotics conducted at Bankstown-Lidcombe Hospital, Australia from June 2014 to April 2015.ResultsThirty one patients were 75 + years and 69 less than 75 years. A greater proportion of older patients resided in nursing home (25.8% vs 2.9% respectively, p = 0.001) and mobilized with walking aid(s) (58.1% vs 11.6% respectively, p < 0.001). Significantly more older patients had documented hypertension (45.2% vs 23.2% respectively p = 0.035), atrial fibrillation (33.5% vs 5.8% respectively, p < 0.001), dementia (22.6% vs 1.4% respectively, p = 0.001) and malignancy (16.1% vs 1.4% respectively, p = 0.010). The clinical presentation of cellulitis and cellulitis severity (Eron classification) did not significantly differ in both groups; however older patients were more likely to have dependent edema (OR 4.0, 95%CI 1.3–12.6, p = 0.018) and less likely to be obese (OR 0.3, 95%CI 0.1–0.8, p = 0.012) or had a past history of cellulitis (OR 0.3, 95%CI 0.1–1.0, p = 0.044) on presentation. Despite the age difference, there were no major differences in intravenous antibiotic choice, hospital length of stay, and hospital readmission rates in both groups. Older patients however, were more likely to experience complications such as falls and/or decreased mobility (38.7% vs 15.9% respectively, p = 0.020) during the cellulitis episode.ConclusionThere are minor differences in the risk factors and clinical features of cellulitis in older patients as compared to the young. Outcomes are similar except for a higher incidence of hospital related complications.

Highlights

Cellulitis is a bacterial infection of the skin involving the dermis and subcutaneous fat
In Australia, cellulitis accounts for over 250,000 hospital bed days, or 10.5% of potentially preventable hospitalizations [1].While most episodes of cellulitis can be managed as an outpatient, a significant proportion, older people, require hospitalization
In this prospective study, we aimed to examine differences in risk factors, clinical features, management, and outcomes of cellulitis between those 75 years or more and those less than 75 years admitted to a large metropolitan hospital

Summary

Introduction

Cellulitis is a bacterial infection of the skin involving the dermis and subcutaneous fat. In Australia, cellulitis accounts for over 250,000 hospital bed days, or 10.5% of potentially preventable hospitalizations [1].While most episodes of cellulitis can be managed as an outpatient, a significant proportion, older people, require hospitalization. Cellulitis typically presents with pain, erythema, warmth and edema. Systemic symptoms including fever and tachycardia may be present thought to be less frequent in older persons [2,3,4,5,6]. Known risk factors for cellulitis are venous edema, lymphedema, skin conditions, traumatic injury, leg ulcers, peripheral vascular disease, fungal infections, past history of cellulitis and obesity [7,8,9,10]

Methods

Results

Conclusion