Variability of antimicrobial prescribing in patients with acute cellulitis.

Mar 2012

Davies MS, Robertson MB, Brown SH, Saunders B, Waring WS.

Source

Acute Medical Unit, York Teaching Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK.

Abstract

PURPOSE:

Clinical guidelines concerning treatment of infection are incorporated into prescribing formularies and antimicrobial stewardship policies. The extent to which these influence prescribing is uncertain. In this study, we sought to examine antimicrobial prescribing patterns in patients with cellulitis.

METHODS:

Consecutive adults admitted to hospital due to acute cellulitis between 2008 and 2010 were studied. Data collected were clinical and laboratory markers of sepsis, antimicrobial agent, route of administration, number of i.v. dosages, duration of antimicrobial treatment, and hospital length of stay. Three groups were defined by prescribing that was (i) identical to formulary, (ii) modified appropriately due to microbiological data or prior drug allergy, and (iii) nonformulary prescribing. Comparisons were made between groups using Mann-Whitney tests.

RESULTS:

There were 306 patients: 167 men (54.6%), median age 66 (range 18-100) years. Prescribing was consistent with formulary recommendations in 253 (82.7%), modified appropriately in 24 (7.8%), and nonformulary in 29 (9.5%). Median [interquartile range (IQR)] duration of hospital stay was 5 (3-8), 7 (5-9, P = 0.026), and 7 (5-14, P = 0.0006) days, and overall duration of antimicrobial therapy was 12 (9-16), 13 (8-15), and 15 (12-19, P = 0.0479) days, respectively. No differences were observed in clinical or laboratory markers of sepsis.

CONCLUSIONS:

Prescribing patterns accorded with prevailing guidelines in the majority of patients. Nonetheless, there was nonformulary prescribing in 10% of patients, and this could not be explained by clinical or laboratory measures of disease severity. Further work is needed to explore the factors that contribute to nonformulary prescribing in this group of patients.

SpringerLink

Swollen, red leg calls for immediate treatment

Feb 28, 2012

BY PAUL G. DONOHUE, M.D.

DEAR DR. DONOHUE: Recently my left leg has swollen from below the knee down to the ankle and foot. There also is some redness of the skin. Did I get a spider bite, or what? What is the remedy? -- D.Z.

ANSWER: I suppose it could be a spider bite, but the first thought that comes to mind is cellulitis, an infection of the skin and the tissues beneath the skin. The leg is one of the prime sites where this happens. It's a condition that calls for prompt antibiotic treatment. I hope you have seen a doctor before waiting for this to appear in the paper.

Another possibility is a blood clot in one of the leg veins, thrombophlebitis (THROM-boh-flea-BITE-us). It, too, is an emergency situation.

A third cause is obstruction or inflammation of lymph vessels. Lymph is fluid that circulates between cells and tissues. Lymph vessels, also called lymphatics, vacuum up the fluid and return it to the circulation.

The rupture of a Baker's cyst, a behind-the-knee bulge, causes similar signs. It's very painful, and I am sure you wouldn't hesitate to see a doctor if this happened.

I'm not suggesting any treatment because all of these diagnoses are serious and need quick attention. I hope you have gotten it.

Read more: Yuma Sun

Generally, cellulitis is caused by a bacterial agent. It can however, be caused by a fungus as well as this abstracts states:

Invasive Mycoleptodiscus fungal cellulitis and myositis.

Koo S, Sutton DA, Yeh WW, Thompson EH, Sigler L, Shearer JF, Hofstra DE, Wickes BL, Marty FM.

Source

* Division of Infectious Diseases, Brigham & Women's Hospital , Boston.

Abstract

We report progressive necrotizing fungal cellulitis and myositis in the leg of a patient with glioblastoma multiforme treated with temozolomide and corticosteroids. While the morphologic appearance of the isolate and its ability to grow at temperatures greater than 32°C were suggestive of Mycoleptodiscus indicus, some of the conidia were atypical for this species in that they had single septa and occasional lateral appendages. Furthermore, the isolate was different from M. indicus based on the sequencing analysis of two rDNA regions. This is the first case of Mycoleptodiscus invasive fungal disease in which the causative agent could not be resolved at the species level because of inconsistencies between morphological and molecular data.

Informa