Cellulitis incidence in a defined population

Epidemiology and Infection

Copyright © 2005 Cambridge University Press
Copyright © 2005 Cambridge University Press
doi:10.1017/S095026880500484X
Published Online

S. M. ELLIS SIMONSEN a1, E. R. VAN ORMAN a1, B. E. HATCH a1, S. S. JONES a1, L. H. GREN a1, K. T. HEGMANN a1 and J. L. LYON a1c1a1

Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA

Abstract

A population-based insurance claims database was used to examine cellulitis incidence, anatomical sites of infection, complicating diagnoses, source of health service, and recurrence rates. Insurance claim files were searched for cellulitis ICD-9-CM codes 681.0–682.9. Complications of cellulitis including erysipelas, lymphadenitis, lymphangitis, and necrotizing fasciitis were also identified by ICD-9-CM codes. We found a cellulitis incidence rate of 24·6/1000 person-years, with a higher incidence among males and individuals aged 45–64 years. The most common site of infection was the lower extremity (39·9%). The majority of patients were seen in an outpatient setting (73·8%), and most (82·0%) had only one episode of cellulitis during the 5-year period studied. There was a very low incidence of cellulitis complications, including necrotizing fasciitis. Cellulitis is fairly common, usually treated in outpatient settings, and is infrequently complicated by erysipelas, lymphadenitis, lymphangitis, or necrotizing fasciitis.

(Accepted April 27 2005)

Correspondence:c1 Department of Family and Preventive Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA. (Email: jlyon@dfpm.utah.edu)

Cambridge Journals Online

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At Risk Populations

Individuals withthe following conditions are at higher risk of cellulitis then the general population and special consideration should be taken in account in the treatment, management and prevention of the infection.

• Diabetes
• Immunodeficiency - of any type
• Other systemic illness
• Varicella
• Impaired peripheral circulation (arterial insufficiency stasis)
• Lymphandenectomy following tumor excision, such as mastectomy
• Postvenectomy status following saphenous vein stripping
• Individuals with regular or chronic steroid use
• Lymphedema and lymphatics obstructions
• Cancer patients undergoing treatment, especially chemotherapy
• Acute burn patients
• patients with systemic lupus erythematous (SLE)

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Related Article:

Risk factors for acute cellulitis of the lower limb: a prospective case-control study.

Bjornsdottir S, Gottfredsson M, Thorisdottir AS, Gunnarsson GB, Rikardsdottir H, Kristjansson M, Hilmarsdottir I.Department of Medicine, Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland.

BACKGROUND:

Acute bacterial cellulitis is a potentially serious infection that commonly recurs. The identification of preventable risk factors could reduce infection-related morbidity and cost and improve patient management. The aim of this study was to identify the risk factors associated with lower-limb cellulitis, including both analysis of risk factors associated with cellulitis in either limb and risk factors in a single limb associated with cellulitis in the same limb. We placed particular emphasis on dermatophytic infections of the foot and bacterial infection and colonization of the toe webs. METHODS: We conducted a prospective case-control study of 100 subjects with cellulitis and 200 control subjects, matched for age and sex, who were admitted to a university hospital during the period October 2000-February 2004. Data were obtained with a questionnaire and from examination of lower limbs and microbiological analyses of samples from the feet.

RESULTS:

The median age of the participants was 66.5 years (interquartile range, 48.8-77.0). The following risk factors were strongly and independently associated with cellulitis: previous history of cellulitis (OR, 31.04; 95% CI, 4.15-232.20), the presence of Staphylococcus aureus and/or beta -hemolytic streptococci in the toe webs (OR, 28.97; 95% CI, 5.47-153.48), presence of leg erosions or ulcers (OR, 11.80; 95% CI, 2.47-56.33), and prior saphenectomy (OR, 8.49; 95% CI, 1.62-44.52). Tinea pedis interdigitalis was associated with cellulitis only when toe web bacteria were excluded from the analysis (OR, 3.86; 95% CI, 1.32-11.27).

CONCLUSIONS:

Risk factors for acute bacterial cellulitis in hospitalized patients include predisposing factors and the presence of sites of pathogen entry on legs and toe webs. These findings indicate that improved awareness and management of toe web intertrigo, which may harbor bacterial pathogens, and other skin lesions might reduce the incidence of cellulitis.

University of Chicago Press