Cellulitis and treatment: a qualitative study of experiencesBr

Cellulitis and treatment: a qualitative study of experiences

Br J Nurs. 2007 Mar 22-Apr 11

Carter K, Kilburn S, Featherstone P.Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth.

Although cellulitis is usually a relatively mild condition, it is potentially life threatening, often necessitating emergency treatment in either the acute or community care settings. The treatment of cellulitis with antibiotics is well established, with effectiveness generally measured against purely biochemical and clinical outcomes (Cox, 2002). Although important, these outcomes are centred purely on the disease process from the medical perspective and little is known about patients' experiences of cellulitis.

This qualitative study explores patients' view on the management of community-acquired cellulitis in the secondary healthcare setting. Data were collected through semi-structured groups and individual telephone interviews. Participants were selected through purposive sampling and the Framework Analysis Technique was used to analyse the data.

Three superordinate themes emerged: initial presentation/motivation for seeking help; confidence and satisfaction; anxiety and dissatisfaction. Severe pain was almost universally a cause of distress and flu-like symptoms delayed recognition. Health information and communication was generally poor.

Participants largely welcomed a move from inpatient to day-patient or outpatient care provided there was adequate information and support. To meet the diverse needs of cellulitis patients, services must be more flexible and tailored to the needs of the individual. Patients are often not told what they can do to prevent recurrence.

PMID: 17505397 [PubMed - in process]

Incidence of lower-extremity cellulitis: a population-based study in olmsted county, Minnesota.

Incidence of lower-extremity cellulitis: a population-based study in olmsted county, Minnesota.
Mayo Clin Proc. 2007 Jul

McNamara DR, Tleyjeh IM, Berbari EF, Lahr BD, Martinez JW, Mirzoyev SA, Baddour LM.
Division of Infectious Diseases, MeritCare Health System, PO Box MC, Fargo, ND 58122 (e-mail: mcnamara.david@mayo.edu).

OBJECTIVE: To determine the population-based incidence of lower-extremity cellulitis.

METHODS: We performed a population-based survey with the resources of the Rochester Epidemiology Project in Olmsted County, Minnesota. We identified residents of Olmsted County who sought care for cellulitis from January 1, 1999, through December 31, 1999, reviewed medical records to ascertain agreement with a case definition of lower-extremity cellulitis, and calculated the population-based incidence of lower-extremity cellulitis.

RESULTS: During 1999, 176 episodes met the case definition of lower-extremity cellulitis; the incidence of lower-extremity cellulitis in Olmsted County was 199 per 100,000 person-years. Sex-specific incidence was 197 per 100,000 person-years for women and 201 per 100,000 person-years for men. In a sex-adjusted model, the incidence increased 3.7% (95% confidence interval, 2.9%-4.5%) per year increment in age or 43.8% (95% confidence interval, 33.6%-54.7%) per 10-year increment. The incidence of cellulitis significantly increased with age (P less than .001 in Poisson regression) but was not statistically significantly different between the sexes.

CONCLUSIONS: The incidence of lower-extremity cellulitis in this population-based study was high and was affected by age. In contrast, sex did not influence infection incidence. The need for hospitalization and the prevalence of recurrence of lower-extremity cellulitis added to the burden of disease in Olmsted County.

Mayo Clinic

Molecular typing of beta-hemolytic streptococci from two patients with lower limb cellulitis: identical isolates in toe web and blood specimens.

Molecular typing of beta-hemolytic streptococci from two patients with lower limb cellulitis: identical isolates in toe web and blood specimens.

J Clin Microbiol. 2007 Jul 3;

Ingibjörg Hilmarsdóttir* and Freyja Valsdóttir
Department of Microbiology, Landspítali University Hospital, Reykjavík, Iceland
* To whom correspondence should be addressed. Email: ingibjh@landspitali.is

Hilmarsdóttir I, Valsdóttir F.
Department of Microbiology, Landspítali University Hospital, Reykjavík, Iceland.

Intertriginous toe webs harbouring cellulitis-causing bacteria constitute a risk factor for lower limb cellulitis. Molecular typing of Streptococcus pyogenes and S. dysgalactiae subspecies equisimilis isolates from blood and toe webs of two cellulitis patients revealed identical strains for each species. This finding supports the role of toe webs as a potential site of entry for cellulitis pathogens.

Journal of Clinical Microbiology

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

Clin Infect Dis. 2005 Nov

Björnsdóttir S, Gottfredsson M, Thórisdóttir AS, Gunnarsson GB, Ríkardsdóttir H, Kristjánsson M, Hilmarsdóttir I.
Department of Medicine, Division of Infectious Diseases, Landspítali 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 Journals * Full Text Article