Methods: Three tertiary hospital ERs routinely referred all cases of cellulitis requiring outpatient IV antibiotics to a central ER-staffed cellulitis clinic. In October 2014 the policy was changed to refer all cellulitis patients to an ID specialist-run cellulitis clinic. A retrospective chart review was performed of all patients seen by the ER clinic in the last 4 months prior to the change in policy (n=149) and those seen by ID in the first 3 months of the mandatory ID consult policy (n=136).
Results: There was no significant difference in mean age, sex ratio, or prevalence of diabetes between groups. Of the patients referred to the ID cellulitis clinic from the ER, only 80/136 (59%) were diagnosed with true cellulitis by ID specialists. Fixty-six patients (41%) were given a different diagnosis requiring alternative management. Antibiotics were discontinued immediately in 16 patients (12%) following ID consultation. After being referred to ID, the rate of recurrence of the presenting condition requiring reinstitution of IV therapy was significantly lower than for those followed by the ER (7.4% vs. 32.9%, p<0.001), as were the rates of hospitalization (1.5% vs. 7.4%, p = 0.02). There was no significant difference in mortality between groups.
Conclusion: Mandatory ID consultation following diagnosis of cellulitis in the ER was beneficial in differentiating mimickers from true cellulitis, reducing rates of recurrent cellulitis, and preventing hospital admissions.
K. Gupta, None
S. Hosseini-Moghaddam, None
W. Thompson, None
S. Elsayed, None
R. Dagnone, None
M. Silverman, None
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