2361. Factors associated with sepsis development in cellulitis. A prospective analysis of 606 episodes in adult patients
Session: Poster Abstract Session: Skin and Skin Structure Infection
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Abst 69266 7 ID WKSF 2018.pdf (262.4 kB)
  • Background: Cellulitis, a frequent cause of admission of adult patients to medical wards, occasionally evolves to sepsis. In this study we analyze the factors related to sepsis development.

    Methods: Prospective and observational study of 606 adult patients with cellulitis admitted to several Spanish hospitals. Comorbidities, microbiological, clinical, lab, diagnostic, and treatment data were analyzed. Sepsis was diagnosed according to the criteria of the 2016 International Sepsis Definitions Conference. Multiple logistic regression modelling was performed to determine the variables independently associated with sepsis development.

    Results: Mean age was 63.4 years and 51.8% were men. Overall 65 (10.7%) patients developed sepsis, 7 (10.8%) of whom died, but only 4 (6.2%) due to cellulitis. Drawing of blood (P<0.0001) or any (P<0.0001) culture, and identification of the agent (P=0.005) were more likely among septic patients. Septics had also a longer duration of symptoms (P=0.04), higher temperature (P=0.03), more extensive cellulitis (P=0.02), higher leukocyte (P<0.0001) and neutrophil (P<0.0001) counts, serum creatinine (P=0.001), and CRP (P=0.008) than non-septics. Regarding therapy, septic patients were more likely to undergo changes in the initial antimicrobial regimen (P<0.0001), received more antimicrobials (P<0.0001), were intravenously treated for longer (P=0.03), and underwent surgery more commonly (P=0.01) than non-septics. Death (P=0.002), leukocyte counts (P=0.002), serum creatinine (P=0.003), drawing of blood cultures (P=0.004), change of the initial antimicrobial regimen (P=0.007) and length of cellulitis (P=0.009) were independently associated with sepsis development in the multivariate analysis. The area under the ROC curve of a formula derived from blood leukocytes and serum creatinine for predicting sepsis development was 0.732 (95% CI 0.659–0.805), P<0.0001, and its most discriminant cut-off value had a sensitivity 67.7% and specificity 74.4% for this purpose.

    Conclusion: Death, increased blood leukocytes and serum creatinine, blood culture drawn, modification of the initial antimicrobial regimen, and maximum length of cellulitis were associated with sepsis development in cellulitis patients.

    Julio Collazos, MD, PhD1, Belen De La Fuente, MD, PhD2, Alicia Garcia, MD3, Helena Gomez, GOMEZ3, Candela Menendez, MD3, Hector Enriquez, MD4, Paula Sanchez, MD5, Maria Alonso, MD4, Jose Guerra, MD, PhD6, Arturo Artero, MD, PhD7, Marino Blanes, MD, PhD8, Javier De La Fuente, MD, PhD4 and Victor Asensi, MD, PhD9, (1)Infectious Diseases, HOSPITAL DE GALDACANO, GALDACANO, Spain, (2)Medicine, HOSPITAL DE CABUEÑES, GIJON, Spain, (3)Medicine, HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS, OVIEDO UNIVERSITY SCH.MEDICINE, OVIEDO, Spain, (4)Medicine, HOSPITAL DE POVISA, VIGO, Spain, (5)HOSPITAL DE POVISA, VIGO, Spain, (6)Medicine, HOSPITAL DE LEON, LEON, Spain, (7)Medicine and Infectious Diseases, HOSPITAL DR PESET, VALENCIA, Spain, (8)Infectious Diseases, HOSPITAL LA FE, VALENCIA, Spain, (9)Medicine and Infectious Diseases, HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS, OVIEDO UNIVERSITY SCH.MEDICINE, OVIEDO, Spain

    Disclosures:

    J. Collazos, None

    B. De La Fuente, None

    A. Garcia, None

    H. Gomez, None

    C. Menendez, None

    H. Enriquez, None

    P. Sanchez, None

    M. Alonso, None

    J. Guerra, None

    A. Artero, None

    M. Blanes, None

    J. De La Fuente, None

    V. Asensi, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.