Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis

Strazzula, Lauren; Cotliar, Jonathan; Fox, Lindy P.; Hughey, Lauren C.; Shinkai, Kanade; Gee, Sarah N.; Kroshinsky, Daniela

doi:10.1016/j.jaad.2014.11.012

Cited by 71 publications

(60 citation statements)

References 15 publications

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“…However, some of these patients may be misdiagnosed and may instead have stasis dermatitis, lipodermatosclerosis, or contact dermatitis as an example, and thus would not have responded to treatment with intravenous antibiotics. The distinction of cellulitis among its mimics is based primarily on morphological features, and several studies have highlighted challenges in diagnostic accuracy among physicians given the broad differential diagnosis for the red leg [11][12][13] . Coordinating follow-up care for candidates at higher risk of readmission with consultants who may aptly distinguish common mimics of LLC also has the potential to diminish direct and indirect costs associated with rehospitalization, while improving quality and satisfaction of care.…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

et al. 2017

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Background: There is substantial allocation of resources directed towards evaluation and management of lower limb cellulitis (LLC) in the acute care setting. Readmission for LLC is poorly understood, and there is little evidence with which to identify patients at risk for readmission. Objective: To describe demographics, comorbidities, admission vital signs, and laboratory markers of infection among patients with LLC who are readmitted, and to investigate which among these factors is associated with readmission. Methods: A cross-sectional retrospective cohort study was performed at tertiary and community hospitals within a regional health care system in order to summarize readmission characteristics. Univariate and multivariate models were created to estimate the likelihood of independent variables being associated with LLC readmission. Results: The readmission rate was 11.2% with a median age of 68.6 years for the cohort. Increased age and subsidized insurance were associated with more frequent admissions. For every 10-year age increase, cellulitis subjects had a 14% increase in readmission odds (OR 1.14, CI 1.07-1.20). Patients with subsidized insurance had an almost twofold increased risk (OR 1.88, CI 1.42-2.50). Smoking, obesity, hypertension, diabetes mellitus, renal insufficiency, tachycardia, hypotension, leukocytosis, and neutrophilia were not more frequent in readmitted patients. Conclusions: Older age and subsidized insurance were associated with readmission whereas severity indicators for infection including abnormal vital signs and laboratory markers were not significantly associated. Factors other than severity of infection, such as socioeconomic factors, may influence clinical decisions related to readmission for LLC.

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Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

et al. 2017

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“…Erizipel benzeri eritemin ayırıcı tanısında sellülit, erizipel, eritema nodozum, eritema induratum, staz dermatiti de akılda bulundurulmalıdır [7,8]. EBE paraneoplastik bir bulgu olarak da gelişebilmektedir.…”

Section: Olgu Sunumuunclassified

Ailesel Akdeniz Ateşi Atağına Eşlik Eden Erizipel Benzeri Eritem

Acar¹,

Şaş²

2017

Dicle Tıp Dergisi

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ÖzetAilevi Akdeniz Ateşi (AAA) tekrarlayan ateş ve poliserozitle karakterize, en sık görülen ailesel, monogenik geçişli otoinflamatuar bir hastalıktır. Erizipel benzeri eritem AAA'nın tipik ancak nadir görülen bir deri bulgusudur. Alt ekstremitelerde, dizin alt kısmı, ayak sırtında ve ayak bileğinde yerleşim gösteren sıcak ve hassas eritematöz plaklarla karakterizedir. Özellikle AAA'nın başlangıç bulgusu olarak ortaya çıktığında erizipel olarak değerlendirilerek yanlış tanı konabilmektedir. Burada, AAA tanısı ile takipte olan ve kolşisin tedavisine uyum göstermeyen ve sonrasında AAA atağıyla birlikte erizipel benzeri eritemle başvuran 24 yaşında bir erkek hasta sunulmaktadır. Anahtar kelimeler: Ailesel Akdeniz Ateşi, erizipel, eritem Erysipelas Like Erythema Accompanying Familial Mediterranean Fever Attack AbstractFamilial Mediterranean Fever (FMF) is the most common familial monogenic autoinflamatory disease characaterized by recurrent fever and polyserositis. Erysipelas like erythema is a typical but rare cutaneous finding in FMF and characterized by tender erythematous plaques located on lower limbs, leg, dorsum of the foot and ankle. The lesions can be misdiagnosed as eryspileas especially when seen as a initial symptom of FMF. We present here an example of erysipelas like erythema accompanying FMF attack as a result of non-adherence to oral colchicine treatment.

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“…Dermatology consultation can be an important tool to help with the diagnosis of dermatologic findings in critically ill patients and reduce antimicrobial use in those with non-infectious conditions [53, 54]. Many dermatologic conditions can mimic infections, for which dermatologist expertise can be helpful in distinguishing; including pyoderma gangrenosum and pustular psoriasis, among others (Table 4) [55].…”

Section: Icu‑specific Infectionsmentioning

confidence: 99%

“…In addition to the SSTI mimetics in Table 4, the differential diagnosis for dermatologic findings in the immunocompromised host should include drug eruptions (especially patients on chemotherapy), skin metastases, local invasion of tumor burden, leukocytoclastic vasculitis, graft-versus-host disease in stem cell transplant patients, and a broader infectious differential including invasive fungal and mold infections, mycobacterial infections, and parasitic infections such as disseminated strongyloidiasis [9]. Given the broader differential diagnosis and greater potential for decompensation, early dermatologic consultation with biopsy and culture may be beneficial [9, 53]. All immunocompromised patients that are critically ill should undergo thorough cutaneous examination as immunosuppression tends to reduce physical exam findings of SSTI.…”

Section: Special Considerationsmentioning

confidence: 99%

Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review

2016

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Purpose: To review the salient features of the diagnosis and management of the most common skin and soft tissue infections (SSTI). This review focuses on severe SSTIs that require care in an intensive care unit (ICU), including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis. Methods: Guidelines, expert opinion, and local institutional policies were reviewed. Results: Severe SSTIs are common and their management complex due to regional variation in predominant pathogens and antimicrobial resistance patterns, as well as variations in host immune responses. Unique aspects of care for SSTIs in the ICU are discussed, including the role of prosthetic devices, risk factors for bacteremia, and the need for surgical consultation. SSTI mimetics, the role of dermatologic consultation, and the unique features of SSTIs in immunocompromised hosts are also described. Conclusions: We provide recommendations for clinicians regarding optimal SSTI management in the ICU setting.

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Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: A multi-institutional analysis

Cited by 71 publications

References 15 publications

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

Clinical Factors Associated with Readmission among Patients with Lower Limb Cellulitis

Ailesel Akdeniz Ateşi Atağına Eşlik Eden Erizipel Benzeri Eritem

Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review

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