Risk stratification and outcome of cellulitis admitted to hospital

详细信息    查看全文

• 作者：M. Figtree ; P. Konecny ; Z. Jennings ; C. Goh ; S.A. Krilis ; S. Miyakis
• 关键词：Cellulitis ; Erysipelas ; Skin infection ; Soft tissue infection ; cSSSI ; MRSA
• 刊名：Journal of Infection
• 出版年：2010
• 出版时间：June 2010
• 年：2010
• 卷：60
• 期：6
• 页码：431-439
• 全文大小：378 K

文摘

Summary

Objectives

To identify risk factors associated with mortality and adverse outcome of community acquired cellulitis/erysipelas requiring hospital admission.

Methods

A retrospective analysis of 395 episodes of cellulitis/erysipelas admitted to a tertiary referral hospital between January 1999 and December 2006.

Results

Mortality was 2.5 % (10/395). There were 112 complications (28.4 % ). Median hospitalisation was 5 days. Factors independently associated with mortality, adverse outcome and prolonged stay (>7 days) were bacteraemia and albumin <30 g/L. A risk stratification model was designed based on factors independently associated with adverse outcome: altered mental status, neutrophilia/paenia, discharge from the cellulitic area, hypoalbuminaemia and history of congestive cardiac failure. Adverse outcome risk among patients with scores <4, 6–9 and >9 was <20 % , 55 % and 100 % , respectively. All patients who died had admission score ≥4. Factors independently associated with prolonged hospitalisation were: age >60, symptom duration >4 days, hypoalbuminaemia, bacteraemia, isolation of MRSA and time to effective antibiotics >8 h. MRSA was more frequent among patients admitted during 2003–2006 (OR 2.43, 95 % CI: 1-12-5.27). Streptococci accounted for most bacteraemia (11/20). Infectious Disease physician input was independently associated with shorter hospitalisation.

Conclusions

Cellulitis/erysipelas requiring hospitalisation confers considerable morbidity and mortality. Clinical markers present on admission can be used to stratify patient risk of mortality and adverse outcome.