Abstract
ObjectivesSex differences in adult cellulitis, a frequent cause of hospitalization, have not been analyzed. These differences were investigated in a large cellulitis series. MethodsThis was a prospective observational study of 606 Spanish hospitalized cellulitis patients. Different comorbidities, clinical, diagnostic, and treatment data were compared between the sexes. Multiple logistic regression modeling was performed to determine the variables independently associated with sex. ResultsOverall 606 adult cellulitis patients were enrolled; 314 (51.8%) were male and 292 (48.2%) were female. Females were older (mean age 68.8 vs 58.9 years, p < 0.0001), less likely to have prior wounds (p = 0.02), and more likely to have venous insufficiency (p = 0.0002) and edema/lymphedema (p = 0.0003) than males. The location of the infection differed between the sexes (p = 0.02). Males were more likely to have positive pus cultures (p = 0.0008), the causing agent identified (p = 0.04), and higher rates of Staphylococcus aureus infection (p = 0.04) and received longer antibiotic treatment (p = 0.03). Factors independently associated with female sex in the multivariate analysis were older age (p < 0.0001), prior cellulitis (p = 0.01), presence of edema/lymphedema as the predisposing factor (p = 0.004), negative versus positive pus culture (p = 0.0002), and location of cellulitis other than in the lower extremities (p = 0.035). ConclusionsDifferences between male and female patients with cellulitis were age, recurrence, presence of edema/lymphedema, positivity of pus culture, and topography of the infection.
Highlights
Cellulitis, a common type of skin and soft tissue infection (SSTI), is a frequent cause of hospital admission for adult patients, representing 1–14% of emergency room visits and 4–7% of hospital older strata, and the average costs per hospitalization for SSTI in 2001 amounted to 5346 euros (Goettsch et al, 2006).Despite its frequency, substantial resource requirements, heavy economic burden for healthcare systems, and huge numbers of papers published, studies analyzing sex-related differences in SSTI are lacking
The incidence of cellulitis was found to be higher in men in a population-based study from Utah (Ellis Simonsen, 2006), whereas another population-based study from Minnesota did not find any difference between the sexes (McNamara et al, 2007) and a subsequent study by the same Minnesota group found a significantly higher incidence in males (Marcelin et al, 2017)
It is remarkable that no study to date appears to have evaluated the possible sex differences in such a frequent and relevant bacterial infection, and we believe that a study on this topic might be helpful for the knowledge, prevention, and management of this condition
Summary
Cellulitis, a common type of skin and soft tissue infection (SSTI), is a frequent cause of hospital admission for adult patients, representing 1–14% of emergency room visits and 4–7% of hospital older strata, and the average costs per hospitalization for SSTI in 2001 amounted to 5346 euros (Goettsch et al, 2006).Despite its frequency, substantial resource requirements, heavy economic burden for healthcare systems, and huge numbers of papers published, studies analyzing sex-related differences in SSTI are lacking. A limited number of retrospective studies with different designs and objectives, and sometimes contradictory results, have indirectly mentioned certain sex-related issues, mainly differences in incidence rate. The incidence of cellulitis was found to be higher in men in a population-based study from Utah (Ellis Simonsen, 2006), whereas another population-based study from Minnesota did not find any difference between the sexes (McNamara et al, 2007) and a subsequent study by the same Minnesota group found a significantly higher incidence in males (Marcelin et al, 2017). Male sex was associated with death in a retrospective study with a small number of events (Carratalá et al, 2003), and women had non-significantly shorter hospital stays than men in two other small studies (PerellóAlzamora, 2012; Kosior and Reich, 2019).
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