Lower extremity cellulitis (LEC) is common, with substantial morbidity and high costs of care for hospitalizations and recurrent episodes, but little published data regarding hospitalizations for LEC. Though uncommon, bloodstream infections (BSI) can complicate LEC, with prolonged hospitalization, need for intravenous (IV) antibiotics, and potential mortality in high risk patients. To date, a population-based study evaluating the epidemiology, management and hospitalizations for LEC, including distribution of BSI attributed to LEC has not been performed in the United States; therefore we aimed to study this.
We conducted a retrospective, population-based study of adult Olmsted County residents with ICD-9 codes corresponding to LEC in 2013. We reviewed individual charts to confirm LEC. Patients with purulent skin/soft tissue infections were excluded.
Of the 280 patients identified with ≥1 episode of LEC in 2013, 56% were male, median age was 58.9 years, and 38 patients (14%) required hospitalization. Hospitalized patients (HP) had shorter symptom duration prior to presentation than outpatients (median, 2 vs. 3 days; p=0.002), and were more likely to have fever (p<0.001), among those with data available. HP were significantly more likely to have blood tests performed (including blood cultures), require >1 antibiotic and were treated for a longer duration than outpatients (12 vs. 9 days; p<0.001). All patients received antibiotics; 79% received oral antibiotics alone. The most utilized oral antibiotic was cephalexin (64%) and the most utilized IV antibiotic was ceftriaxone (10%). Thirty-one patients had blood cultures done, 27 of whom were HP. Only 5 patients’ blood cultures were positive and in 1 of the 5 cases, skin flora contamination accounted for BSI.
Patients requiring hospitalization were more likely to have fever and a shorter duration of symptoms. The rate of BSI in our population-based cohort was 2%, suggesting that other studies may overestimate BSI rates in referral center cohorts. Because systemic symptoms generally resolve quickly after initiation of appropriate antibiotic therapy, patient management schemes that avoid or shorten hospitalizations for patients with LEC are essential.
J. R. Marcelin,
D. Challener, None
B. Lahr, None
L. M. Baddour, None
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