Clinical characteristics of patients with lower limb cellulitis and antibiotic usage in Hospital Kuala Lumpur: a 7-year retrospective study.

Abstract

Cellulitis commonly involved lower limbs. This study was carried out to determine the demography, clinical characteristics, risk factors, microbiological aspects, and antibiotics usage in this group of patients in Hospital Kuala Lumpur. A total of one hundred and twenty four patients with lower limb cellulitis treated in the Department of Dermatology, Hospital Kuala Lumpur, between January 2008 and May 2013 were included in this study. There were 70 male and 54 female patients, aged between 13 and 87 years (mean 57.23±12.854). Thirty-one of them (25%) had recurrent cellulitis. Fifty-seven (46%) had fever at presentation, 55 (44.4%) had bullous cellulitis. The top risk factors identified were toe web intertrigo (n = 79, 63.7%), hypertension (n=76, 61.3%), obesity (n = 55, 44.4%), and diabetes (n = 55, 44.4%). However, only toe web intertrigo (p= 0.003), peripheral vascular disease (p = 0.01), and varicose veins (p = 0.02) were significantly higher in recurrent cellulitis. Thirty patients (24.2%) were complicated with lipodermatosclerosis, and six (4.8%) had lymphostasis verrucosa cutis. Skin swab cultures were positive in 54 (43.5%) patients, and Pseudomonas sp. was the most frequently identified organism. Mean number of antibiotics given for one episode of cellulitis was1.7±1. The antibiotics most given were cloxacillin (n=57, 46%) and other penicillins (n= 71, 57%), followed by cephalosporins (n = 40, 32%). Identifying clinical characteristics of those at risk may help to prevent recurrence of cellulitis and long-term complications.