Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study

Abstract

Background Hand infections are heterogeneous, and some may undergo successful outpatient management. There are no strict guidelines for determining which patients will likely require inpatient admission for successful treatment, and many patients succeed with outpatient therapy. We sought to determine risk factors for failed outpatient management of cellulitic hand infections. Methods We performed a retrospective review of patients who presented to the Emergency Department (ED) for hand cellulitic infections over five years, from 2014 to 2019. Vital signs, lab markers, Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Measure (ECM), and antibiotic use were investigated. Discharge from the ED without subsequent admission was considered an outpatient success, while admission within 30 days of the prior visit was considered a failure. Continuous variables were compared with Welch's t test, and categorical data with Fisher's exact tests. Multivariable logistic regression was performed on comorbidities. Multiple testing adjustment was performed on p-values to generate q-values. Results Outpatient management was attempted for 1,193 patients. 31 (2.6%) infections failed treatment, and 1,162 (97.4%) infections succeeded. Attempted outpatient treatment was 97.4% successful. Multivariable analysis demonstrated higher odds of failure with renal failure according to both CCI (OR 10.2, p < 0.001, q = 0.002) and ECM (OR 12.63, p = 0.003, q = 0.01) and with diabetes with complications according to the CCI (OR 18.29, p = 0.021, q = 0.032). Conclusions Outpatient treatment failure was higher in patients with renal failure and complicated diabetes. These patients require a high index of suspicion for outpatient failure. These comorbidities should influence consideration for inpatient therapy though most patients can undergo successful treatment as outpatients. Level of evidence Level III.

Factors for a clinical prediction score to determine complication development after cellulitis diagnosis in adult patients

“…Concerning underlying diseases, diabetes mellitus emerged as the most signi cant factor in this context. Our study's outcomes align with those of Allen's et al previous study 15 , showing the clinical impact of diabetes mellitus on a patient's immune system. Surprisingly, comorbidities of chronic venous insu ciency (N1 = 7, N2 = 87), HIV (N1 = 0, N2 = 17), lymphatic obstruction (N1 = 2, N2 = 19) and peripheral artery disease (N1 = 0, N2 = 24) were not signi cant and did not emerge as independent predictors of complication in patients with cellulitis.…”

Factors and clinical prediction score for complication development after cellulitis diagnosis in adult patients

“…Concerning underlying diseases, diabetes mellitus emerged as the most significant factor in this context. Our study’s outcomes align with those of Allen’s et al previous study [ 15 ], showing the clinical impact of diabetes mellitus on a patient’s immune system. Surprisingly, comorbidities of autoimmune disease (N1 = 3, N2 = 58), malignancy (N1 = 6, N2 = 157), HIV (N1 = 0, N2 = 13), lymphatic obstruction (N1 = 2, N2 = 19) and peripheral artery disease (N1 = 0, N2 = 24) were not significant and did not emerge as independent predictors of complication development in patients with cellulitis.…”

Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions

“…The main causes included three categories: 1) trauma; 2) unknown causes or no history of injuries; and 3) postoperative or iatrogenic causes. [33][34][35][36][37][38][39][40][41] 3.2.2. According to the analysis of results reported in the literature (Table 1, Figure 2), both mixed bacteria (31.2% vs. 16.6%, p=0.014) and fungi (7.5% vs. 0.8%, p=0.017) in nontropical regions were signi cantly higher than those in tropical regions.…”