Clinical features, microbiological epidemiology and recommendations for management of cellulitis in extremity lymphedema

Abstract

BackgroundThis high volume, single center study investigated the prevalence, bacterial epidemiology, and responsiveness to antibiotic therapy of cellulitis in extremity lymphedema.MethodsFrom 2003 to 2018, cellulitis events from a cohort of 420 patients with extremity lymphedema were reviewed. Demographics, lymphedema grading, symptoms, inflammatory markers, cultures and antibiotic therapy regimens were compiled from cellulitis episodes data. Univariate and multivariate analyses were performed for detailed analysis.ResultsA total of 131 separate episodes of cellulitis were recorded from 43 (81.1%) lower limb and 10 (19.9%) upper limb lymphedema patients. The prevalence and recurrence rates for cellulitis in lymphedema patients were 12.6% (53 of 420) and 56.6% (30 of 53), respectively. The most common findings were increased limb circumference (127 of 131; 96.9%) and abnormal C‐reactive protein (CRP) level (86 of 113; 76.1%). Blood cultures were obtained in 79 (60.3%) incidents, with 9 (11.4%) returning positive. Streptococcus agalactiae was the most isolated bacterium (5 of 9; 55.5%).ConclusionsThe cellulitis prevalence and recurrence rate in extremity lymphedema were 12.6%, and 56.6%, respectively. Strongest indicators of cellulitis were increased affected limb circumference and elevated CRP level. Empiric antibiotic therapy began with coverage for Steptococcus species before broadening to anti‐Methicillin‐resistant Staphylococcus aureus and anti‐Gram negatives if needed for effective treatment of extremity lymphedema cellulitis.

Cellulitis in chronic oedema of the lower leg: an international cross‐sectional study

“…The lifetime prevalence is higher than previously reported (7Á95-35Á7%), with direct comparison challenging due to methodological differences. [17][18][19] Wounds, obesity, male sex, diabetes, midline swelling and, particularly, advanced stages of chronic oedema were independent risk factors for cellulitis, while control of swelling was associated with a lower risk. Although risk factors in cellulitis have been studied in a meta-analysis (identifying previous cellulitis, concurrent wounds, leg ulcers, excoriating skin diseases, tinea pedis, obesity and lymphoedema/chronic oedema as risk factors), 9 only one single-centre study has been specifically designed in patients with chronic oedema/lymphoedema.…”

Heparin‐induced thrombocytopenia and thrombosis in primary lymphedema patients who underwent vascularized lymph node transplantations

“…The circumferential difference, which was calculated as the circumference of the lesioned limb decreasing the normal limb divided by the normal limb and multiplied by 100%, was used to evaluate the functional recovery of lymphedematous limbs. The episodes of cellulitis per year were compared between the two groups 34 . A Lymphedema Quality‐of‐Life (LYMQoL) questionnaire was administered preoperatively and 3 years postoperatively 35 .…”

Erisipela E Celulite: Diagnóstico, Tratamento E Cuidados Gerais

“…Pesquisa afirma que o linfedema compromete os sistemas de filtragem bacteriana e possibilita o acesso de bactérias no tecido mole à circulação sistêmica e que a especificação microbiológica, seja por hemocultura ou swab da lesão, é útil, quando positiva, para orientar a antibioticoterapia (16) .…”