Factors Associated with Sepsis Development in 606 Spanish Adult Patients with Cellulitis

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2020 Mar 14

PMID 32164590

Citations 5

Authors

J Collazos

B de la Fuente

J de la Fuente

A Garcia

H Gomez

C Menendez

H Enriquez

P Sanchez

M Alonso

I Lopez-Cruz

M Martin-Regidor

A Martinez-Alonso

J Guerra

A Artero

M Blanes

V Asensi

Affiliations

Soon will be listed here.

Abstract

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 patients with sepsis. These patients 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 patients without sepsis. Regarding therapy, patients with sepsis were more likely to undergo changes in the initial antimicrobial regimen (P < 0.0001), received more antimicrobials (P < 0.0001), received longer intravenous treatment (P = 0.03), and underwent surgery more commonly (P = 0.01) than patients without sepsis. 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.

Conclusions: Increased blood leukocytes and serum creatinine, blood culture drawn, modification of the initial antimicrobial regimen, and maximum length of cellulitis were associated with sepsis in these patients.

Citing Articles

Current approach to skin and soft tissue infections. Thinking about continuity of care.

Blanes Hernandez R, Rodriguez Perez M, Fernandez Navarro J, Salavert Lleti M Rev Esp Quimioter. 2023; 36 Suppl 1:37-45.

PMID: 37997870 PMC: 10793549. DOI: 10.37201/req/s01.10.2023.

High Yield of Blood Cultures in the Etiologic Diagnosis of Cellulitis, Erysipelas, and Cutaneous Abscess in Elderly Patients.

Taniguchi T, Tsuha S, Shiiki S, Narita M, Teruya M, Hachiman T Open Forum Infect Dis. 2022; 9(7):ofac317.

PMID: 35899281 PMC: 9310324. DOI: 10.1093/ofid/ofac317.

Evaluation of qSOFA score, and conjugated bilirubin and creatinine levels for predicting 28-day mortality in patients with sepsis.

Xiao Y, Yan X, Shen L, Wang Q, Li F, Yang D Exp Ther Med. 2022; 24(1):447.

PMID: 35720627 PMC: 9199080. DOI: 10.3892/etm.2022.11374.

Cellulitis: A Review of Current Practice Guidelines and Differentiation from Pseudocellulitis.

Boettler M, Kaffenberger B, Chung C Am J Clin Dermatol. 2021; 23(2):153-165.

PMID: 34902109 DOI: 10.1007/s40257-021-00659-8.

Clinical Features and Etiology of Musculoskeletal Infection with or without Sepsis in the Emergency Department.

Zhang J, Li X, Huang G, Wang A, Zhang F Int J Gen Med. 2021; 14:3511-3516.

PMID: 34295179 PMC: 8290349. DOI: 10.2147/IJGM.S321662.

References

Casado-Verrier B, Gomez-Fernandez C, Pano-Pardo J, Gomez-Gil R, Mingorance-Cruz J, de Celada R . [Community-acquired methicillin resistant Staphylococcus aureus skin and soft tissue infections in Madrid: prevalence study]. Enferm Infecc Microbiol Clin. 2012; 30(6):300-6. DOI: 10.1016/j.eimc.2011.11.011. View

Bystritsky R, Chambers H . Cellulitis and Soft Tissue Infections. Ann Intern Med. 2018; 168(3):ITC17-ITC32. DOI: 10.7326/AITC201802060. View

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

Torres J, Avalos N, Echols L, Mongelluzzo J, Rodriguez R . Low yield of blood and wound cultures in patients with skin and soft-tissue infections. Am J Emerg Med. 2017; 35(8):1159-1161. DOI: 10.1016/j.ajem.2017.05.039. View

Suaya J, Eisenberg D, Fang C, Miller L . Skin and soft tissue infections and associated complications among commercially insured patients aged 0-64 years with and without diabetes in the U.S. PLoS One. 2013; 8(4):e60057. PMC: 3622669. DOI: 10.1371/journal.pone.0060057. View

Moran G, Krishnadasan A, Gorwitz R, Fosheim G, McDougal L, Carey R . Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006; 355(7):666-74. DOI: 10.1056/NEJMoa055356. View

Carratala J, Roson B, Fernandez-Sabe N, Shaw E, del Rio O, Rivera A . Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis. 2003; 22(3):151-7. DOI: 10.1007/s10096-003-0902-x. View

Bauer S, Aubert C, Richli M, Chuard C . Blood cultures in the evaluation of uncomplicated cellulitis. Eur J Intern Med. 2016; 36:50-56. DOI: 10.1016/j.ejim.2016.07.029. View

Raya-Cruz M, Ferullo I, Arrizabalaga-Asenjo M, Nadal-Nadal A, Diaz-Antolin M, Garau-Colom M . [Skin and soft-tissue infections in hospitalized patients: epidemiology, microbiological, clinical and prognostic factors]. Enferm Infecc Microbiol Clin. 2013; 32(3):152-9. DOI: 10.1016/j.eimc.2013.03.004. View

10.

Daum R . Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007; 357(4):380-90. DOI: 10.1056/NEJMcp070747. View

11.

Lipsky B, Kollef M, Miller L, Sun X, Johannes R, Tabak Y . Predicting bacteremia among patients hospitalized for skin and skin-structure infections: derivation and validation of a risk score. Infect Control Hosp Epidemiol. 2010; 31(8):828-37. DOI: 10.1086/654007. View

12.

Lasa J, Fernandez Recalde M, Finn B, Bruetman J, Peroni J, Young P . [Bacteremia in patients hospitalized with cellulitis]. Medicina (B Aires). 2012; 72(4):298-304. View

13.

Perl B, Gottehrer N, Raveh D, Schlesinger Y, Rudensky B, Yinnon A . Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis. 1999; 29(6):1483-8. DOI: 10.1086/313525. View

14.

Montravers P, Snauwaert A, Welsch C . Current guidelines and recommendations for the management of skin and soft tissue infections. Curr Opin Infect Dis. 2016; 29(2):131-8. DOI: 10.1097/QCO.0000000000000242. View

15.

van Daalen F, Kallen M, van den Bosch C, Hulscher M, Geerlings S, Prins J . Clinical condition and comorbidity as determinants for blood culture positivity in patients with skin and soft-tissue infections. Eur J Clin Microbiol Infect Dis. 2017; 36(10):1853-1858. PMC: 5602079. DOI: 10.1007/s10096-017-3001-0. View

16.

Gunderson C, Martinello R . A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2011; 64(2):148-55. DOI: 10.1016/j.jinf.2011.11.004. View

17.

Khawcharoenporn T, Tice A, Grandinetti A, Chow D . Risk factors for community-associated methicillin-resistant Staphylococcus aureus cellulitis--and the value of recognition. Hawaii Med J. 2011; 69(10):232-6. PMC: 3071185. View

18.

Goettsch W, Bouwes Bavinck J, Herings R . Burden of illness of bacterial cellulitis and erysipelas of the leg in the Netherlands. J Eur Acad Dermatol Venereol. 2006; 20(7):834-9. DOI: 10.1111/j.1468-3083.2006.01657.x. View

19.

Paolo W, Poreda A, Grant W, Scordino D, Wojcik S . Blood culture results do not affect treatment in complicated cellulitis. J Emerg Med. 2013; 45(2):163-7. DOI: 10.1016/j.jemermed.2013.01.016. View

20.

Raff A, Kroshinsky D . Cellulitis: A Review. JAMA. 2016; 316(3):325-37. DOI: 10.1001/jama.2016.8825. View