1527. Assessing the Benefits of Referral to Infectious Diseases for Management of Cellulitis Diagnosed in the Emergency Department
Session: Poster Abstract Session: Clinical Infectious Diseases: Soft Tissue Infections (ABSSSIs)
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Slide1.jpg (154.5 kB)
  • Background: Despite established guidelines for the diagnosis and management of cellulitis, treatment failure rates in the Emergency Room (ER) remain high. Recurrent cellulitis is often the result of an underlying condition that may require management beyond simple intravenous (IV) antibiotics (e.g. tinea pedis, infected diabetic foot ulcer, etc). Additionally, several “mimickers” of cellulitis have been identified that lead to over-diagnosis of cellulitis (and resultant inappropriate antibiotic use), and under-treatment of the true presenting condition (e.g. venous stasis, lymphedema, etc.). Infectious Diseases (ID) consultation may be beneficial in differentiating true cellulitis from its mimickers, and identifying and treating underlying conditions that lead to recurrent cellulitis and treatment failure. 

    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.

    Shilpa Jain, MD1, Philip Dwek, MD1, Kaveri Gupta, MD, FRCPC1, Seyed Hosseini-Moghaddam, MD1, William Thompson, MD, FRCPC1, Sameer Elsayed, MD, FRCPC1, Robert Dagnone, MD, FRCPC2 and Michael Silverman, MD, FRCPC1, (1)Medicine, Western University, London, ON, Canada, (2)Emergency Medicine, Western University, London, ON, Canada

    Disclosures:

    S. Jain, None

    P. Dwek, None

    K. Gupta, None

    S. Hosseini-Moghaddam, None

    W. Thompson, None

    S. Elsayed, None

    R. Dagnone, None

    M. Silverman, None

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