Treatment failure definitions for non-purulent skin and soft tissue infections: a systematic review

Yadav, Krishan; Nath, Avik; Suh, Kathryn N.; Sikora, Lindsey; Eagles, Debra

doi:10.1007/s15010-019-01347-w

Cited by 9 publications

(8 citation statements)

References 42 publications

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“…The preliminary primary effectiveness outcome was oral antibiotic treatment failure [ 18 ], defined as a change in antibiotic (change in class of oral antibiotic or escalation to intravenous therapy) within 7 days due to worsening infection. Worsening infection was defined as any of the following: (i) new fever (temperature ≥ 38.0 °C) or persistent fever at follow-up; (ii) increasing area of erythema ≥ 20% from baseline; or (iii) increasing pain ≥ 2 points from baseline using the NRS.…”

Section: Methodsmentioning

confidence: 99%

High-dose cephalexin for cellulitis: a pilot randomized controlled trial

et al. 2023

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Background Up to 3% of all Emergency Department (ED) visits are due to skin and soft tissue infections such as non-purulent cellulitis. The current treatment failure rate is approximately 20%. Evidence is lacking regarding the optimal outpatient management of cellulitis. Objectives To evaluate the feasibility of a randomized trial comparing high-dose (1000 mg) to standard-dose (500 mg) cephalexin to treat ED patients with cellulitis. Methods A parallel arm double-blind randomized controlled pilot trial conducted at two EDs in Canada. Eligible participants were adults (age ≥ 18 years) presenting to the ED with non-purulent cellulitis and determined by the treating emergency physician to be eligible for outpatient management with oral antibiotics. Participants were randomized to high-dose or standard-dose cephalexin four times daily for 7 days. The primary feasibility outcome was participant recruitment rate (target ≥ 35%). The preliminary primary effectiveness outcome was oral antibiotic treatment failure. Results Of 134 eligible participants approached for trial participation, 69 (51.5%, 95% CI 43.1 to 59.8%) were recruited and randomized. After excluding three randomized participants due to an alternate diagnosis, 33 participants were included in each arm. Nineteen eligible cases (14.2%) were missed. Loss to follow-up was 6.1%. Treatment failure occurred in four patients (12.9%) in the standard-dose arm versus one patient (3.2%) in the high-dose arm. A greater proportion had minor adverse events in the high-dose arm. No patients had an unplanned hospitalization within 14 days. Conclusion This pilot randomized controlled trial comparing high-dose to standard-dose cephalexin for ED patients with cellulitis demonstrated a high participant recruitment rate and that a full-scale trial is feasible. High-dose cephalexin had fewer treatment failures but with a higher proportion of minor adverse effects. The findings of this pilot will be used to inform the design of a future large trial. Trial registration This trial was registered at ClinicalTrials.gov (NCT04471246). Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00433-7.

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Section: Methodsmentioning

confidence: 99%

High-dose cephalexin for cellulitis: a pilot randomized controlled trial

et al. 2023

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“…Treatment failure or cellulitis resolution have been variably defined in the literature and a systematic review found treatment failure rates between 0% and 29.5% based on a range of definitions. 8 Several included studies used clinician assessment, which may deviate from the patient's experience or impression. 8,9 This evidence gap can be addressed by assessing the clinical course of cellulitis and correlating this with patient reported and patient-centred outcomes.…”

Section: Introductionmentioning

confidence: 99%

Cellulitis in the Emergency Department: A prospective cohort study with patient‐centred follow‐up

Nightingale,

Etheridge,

Sweeny

et al. 2024

Emerg Medicine Australasia

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ObjectiveThere is substantial practice variation in the management of cellulitis with limited prospective studies describing the course of cellulitis after diagnosis. We aimed to describe the demographics, clinical features (erythema, warmth, swelling and pain), patient‐reported disease trajectory and medium‐term follow‐up for ED patients with cellulitis.MethodsProspective observational cohort study of adults diagnosed with cellulitis in two EDs in Southeast Queensland, Australia. Patients with (peri)orbital cellulitis and abscess were excluded. Data were obtained from a baseline questionnaire, electronic medical records and follow‐up questionnaires at 3, 7 and 14 days. Clinician adjudication of day 14 cellulitis cure was compared to patient assessment. Descriptive analyses were conducted.ResultsThree‐hundred patients (mean age 50 years, SD 19.9) with cellulitis were enrolled, predominantly affecting the lower limb (75%). Cellulitis features showed greatest improvement between enrolment and day 3. Clinical improvement continued gradually at days 7 and 14 with persistent skin erythema (41%) and swelling (37%) at day 14. Skin warmth was the feature most likely to be resolved at each time point. There was a discrepancy in clinician and patient assessment of cellulitis cure at day 14 (85.8% vs. 52.8% cured).ConclusionsA clinical response of cellulitis features can be expected at day 3 with ongoing slower improvement over time. Over one third of patients had erythema or swelling at day 14. Patients are less likely than clinicians to deem their cellulitis cured at day 14. Future research should include parallel patient and clinician evaluation of cellulitis to help develop clearer definitions of treatment failure and cure.

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“…Las infecciones de piel y tejidos blandos (IPTB) son una de las principales causas de consulta por infecciones, precedidas por las infecciones de tracto respiratorio y por las infecciones urinarias (1,2). Las IPTB generan aumentos en la cantidad de consultas ambulatorias y en los gastos en salud en las últimas décadas, además son fuente de gran cantidad de prescripciones antibióticas (3,4). En Colombia, 2,7 % de los pacientes consultan al primer nivel por una IPTB durante 2014 (1,5).…”

Section: Introductionunclassified

Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria

Risueño Blanco

2023

biosalud

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Introducción: Las infecciones de piel y tejidos blandos (IPTB) son frecuente motivo de consulta ambulatoria. El estudio de los factores relacionados con no adecuación antibiótica en IPTB constituye el punto inicial para enfrentar a la resistencia bacteriana. Objetivo: Relacionar los factores de las IPTB no purulentas en pacientes adultos ambulatorios con prescripción inadecuada de antibioticoterapia en una IPS de Palmira en el año 2019. Métodos: Estudio transversal analítico retrospectivo. Se usó muestreo aleatorio simple. Se recolectó información de historias clínicas. El tratamiento antibiótico se consideró adecuado si fue acorde a guías. Se realizó estadística descriptiva de todas las variables, posteriormente se realizaron comparaciones de grupos según sí la terapia antibiótica fue adecuada o no; finalmente, se realizó análisis multivariado para control de confusión. Resultados: Para una muestra de 213 historias clínicas el antibiótico más prescrito fue cefalexina (37,1 %); se encuentra una automedicación antibiótica (13,1 %) y 76,1 % de las prescripciones fueron adecuadas. En el análisis multivariante, la automedicación antibiótica (OR 17,523, IC 95 % 1,127-272,5) y la vía intramuscular (OR 44,358, IC 95 % 1,161-1695,461) se relacionaron con prescripción antibiótica no adecuada. Conclusión: Se recomienda la implementación de guías locales en servicios médicos ambulatorios con afianzamiento en sus directrices y la educación a comunidad respecto a la automedicación antibiótica desde la atención primaria para disminuir la no adecuación de la terapia antibiótica.

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Treatment failure definitions for non-purulent skin and soft tissue infections: a systematic review

Cited by 9 publications

References 42 publications

High-dose cephalexin for cellulitis: a pilot randomized controlled trial

High-dose cephalexin for cellulitis: a pilot randomized controlled trial

Cellulitis in the Emergency Department: A prospective cohort study with patient‐centred follow‐up

Factores relacionados con la prescripción inadecuada de antibioticoterapia en adultos con infecciones de piel en consulta ambulatoria

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