Lower limb cellulitis and its mimics

Hirschmann, Jan V.; Raugi, Gregory J.

doi:10.1016/j.jaad.2012.03.024

Cited by 82 publications

(39 citation statements)

References 109 publications

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“…Vesicles and bullae filled with clear fluid are common. The presence of severe pain, violaceous blisters or bullae, and petechiae or ecchymoses, if widespread or associated with systemic toxicity, may signal a deeper infection such as necrotizing fasciitis [3, 12, 13]. …”

Section: What Is Cellulitis?mentioning

confidence: 99%

“…Lacerations, bite or puncture wounds, scratches, instrumentation (e.g., needles), pre-existing skin conditions or infections (e.g., chicken pox, impetigo, or ulcer), burns, and surgery are more among the common portals of entry. In many cases the skin breaks are not clinically apparent [3, 13, 15]. Bacteremia may contribute to some cases of cellulitis.…”

Section: Pathogenesis and Microbiologymentioning

confidence: 99%

“…Bacteremia may contribute to some cases of cellulitis. The most common site of infection is the lower extremities (up to 70–88% of cases) [3, 13, 14, 20]. Fissured webbing of the toes from maceration, dermatophyte infection, or inflammatory dermatoses is believed to contribute in many cases [3, 13, 15, 21].…”

Section: Pathogenesis and Microbiologymentioning

confidence: 99%

“…These include obesity, chronic edema from venous insufficiency or lymphatic obstruction, previous cellulitis, saphenectomy, and skin barrier disruption especially web toe intertrigo [3, 13, 15, 21–24]. Other putative factors include smoking, previous surgery, and previous antibiotic use [22].…”

Section: Pathogenesis and Microbiologymentioning

confidence: 99%

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Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis?

Horseman

Bowman

2013

Infect Dis Ther

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Methicillin-resistant Staphylococcus aureus (MRSA) has become the dominant strain of Staphylococcus aureus in many communities of the United States. As a result, many clinicians are now empirically covering for this pathogen in the treatment of various skin and soft-tissue infections. Should this practice apply to cellulitis? In order to answer this question, we defined cellulitis and reviewed the pathogenesis, microbiology, and current studies of inpatient and outpatient antimicrobial therapy. The current evidence suggests empirical MRSA coverage for community-acquired cellulitis may not be necessary in non-purulent (non-suppurative) forms of this infection. Most cases are non-purulent and not amenable to culture although antibody studies indicate streptococci are the most common etiologic agents. Current studies of antimicrobial therapy tend to agree with this finding. Empirical beta-lactam therapy directed primarily at streptococci appears sufficient for non-purulent cellulitis regardless of the prevalence of MRSA in the community.

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Section: What Is Cellulitis?mentioning

confidence: 99%

Section: Pathogenesis and Microbiologymentioning

confidence: 99%

Section: Pathogenesis and Microbiologymentioning

confidence: 99%

Section: Pathogenesis and Microbiologymentioning

confidence: 99%

See 2 more Smart Citations

Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis?

Horseman

Bowman

2013

Infect Dis Ther

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“…[10] Recently introduced antibiotics, including the long half-life lipoglycopeptides (oritavancin, telavancin and dalbavancin) also provide opportunities for effective treatment with the potential to avoid hospitalization and outpatient parenteral antibiotic therapy (OPAT) costs. In addition, “automatic” Infectious Disease consultation can improve outcome of NLEC patients diagnosed in the emergency department, by identifying cellulitis mimics[11, 12] (and avoiding antimicrobials), preventing hospitalization, and reducing recurrent episodes. [13]…”

Section: Introductionmentioning

confidence: 99%

Hospital costs for patients with lower extremity cellulitis: a retrospective population-based study

et al. 2017

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Background Hospital admissions for non-purulent lower extremity cellulitis (NLEC) are common and can be prolonged and costly. Newer treatment options and preventive strategies are expected to result in cost savings before implementation, but few studies have quantified the cost of conventional treatment. Methods Using the Rochester Epidemiology Project, the incidence of NLEC in Olmsted County, MN in 2013 was 176.6 per 100,000 persons. The subset of patients who required hospitalization for NLEC in 2013 was determined. Hospital admissions were analyzed retrospectively using standardized cost analysis within several relevant categories. Results Thirty-four patients had an average hospital length of stay of 4.7 days. The median total inpatient cost was $7,341. The median cost per day was $2,087, with 49% due to room and board. Antibiotics administered for treatment of NLEC contributed a median cost of $75 per day of hospitalization, and laboratory and imaging test costs were $73 and $44, respectively, per day of hospitalization. Conclusions Hospitalizations for NLEC can be costly and prolonged with room and board accounting for much of the cost. Therefore, newer management strategies should seek to reduce hospital length of stay and/or avoid inpatient admission to reduce cost.

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Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis

et al. 2017

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of the lower extremity are often misdiagnosed as cellulitis (aka "pseudocellulitis") and treated with antibiotics and/or hospitalization. There is limited data on the cost and complications from misdiagnosed cellulitis. OBJECTIVE To characterize the national health care burden of misdiagnosed cellulitis in patients admitted for treatment of lower extremity cellulitis. DESIGN, SETTING, AND PARTICIPANTSCross-sectional study using patients admitted from the emergency department (ED) of a large urban hospital with a diagnosis of lower extremity cellulitis between June 2010 and December 2012. Patients who were discharged with a diagnosis of cellulitis were categorized as having cellulitis, while those who were given an alternative diagnosis during the hospital course, on discharge, or within 30 days of discharge were considered to have pseudocellulitis. A literature review was conducted for calculation of large-scale costs and complication rates. We obtained national cost figures from the Medical Expenditure Panel Survey (MEPS), provided by the Agency for Healthcare Research and Quality (AHRQ) for 2010 to calculate the hospitalization costs per year attributed to misdiagnosed lower extremity pseudocellulitis.EXPOSURES The exposed group was composed of patients who presented to and were admitted from the ED with a diagnosis of lower extremity cellulitis. MAIN OUTCOMES AND MEASURESPatient characteristics, hospital course, and complications during and after hospitalization were reviewed for each patient, and estimates of annual costs of misdiagnosed cellulitis in the United States. RESULTSOf 259 patients, 79 (30.5%) were misdiagnosed with cellulitis, and 52 of these misdiagnosed patients were admitted primarily for the treatment of cellulitis. Forty-four of the 52 (84.6%) did not require hospitalization based on ultimate diagnosis, and 48 (92.3%) received unnecessary antibiotics. We estimate cellulitis misdiagnosis leads to 50 000 to 130 000 unnecessary hospitalizations and $195 million to $515 million in avoidable health care spending. Unnecessary antibiotics and hospitalization for misdiagnosed cellulitis are projected to cause more than 9000 nosocomial infections, 1000 to 5000 Clostridium difficile infections, and 2 to 6 cases of anaphylaxis annually.CONCLUSIONS AND RELEVANCE Misdiagnosis of lower extremity cellulitis is common and may lead to unnecessary patient morbidity and considerable health care spending.

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Lower limb cellulitis and its mimics

Cited by 82 publications

References 109 publications

Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis?

Is Community-Acquired Methicillin-Resistant Staphylococcus aureus Coverage Needed for Cellulitis?

Hospital costs for patients with lower extremity cellulitis: a retrospective population-based study

Costs and Consequences Associated With Misdiagnosed Lower Extremity Cellulitis

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