Risk factors for abscess formation in patients with superficial cellulitis (erysipelas) of the leg.

Risk factors for abscess formation in patients with superficial cellulitis (erysipelas) of the leg.

Dec 2012

Picard D, Klein A, Grigioni S, Joly P.

Source

Department of Dermatology, Inserm U905, Institute for Research and Innovation in Biomedicine (IRIB), Rouen University Hospital, University of Normandy, Rouen, France Nutrition unit and EA4311, Institute for Research and Innovation in Biomedicine (IRIB), Rouen University Hospital, University of Normandy, Rouen, France.

Abstract

Background:  Superficial cellulitis of the leg (erysipelas) is a frequent skin infection. Abscess formation is the most frequent local complication. Determinants of abscess formation in patients with leg cellulitis have not been clearly established yet. 

The aim of this study was to assess risk factors for abscess formation in patients with leg cellulitis.

Patients and methods:  The clinical, biological and bacteriological records of all patients referred to the Dermatology Department of a University Hospital for superficial cellulitis of the leg during a 3-year period were retrospectively reviewed. Using univariate and multivariate analysis, main patients' characteristics at baseline were compared between the group of patients who developed abscess and the group who did not. 

Results:  One-hundred-and-sixty-four patients (93 females, 71 males) of mean age 65±18 years were included. Abscess occurred in 13 cases (8%). The following general factors were positively associated with abscess formation: male gender, smoking, alcohol abuse, delayed introduction of antibiotic treatment. Based on multivariate analysis, only chronic alcohol abuse (OR=4.3, 95%CI:1.08-20.57) and delayed antibiotic treatment initiation (OR=1.4, 95%CI:1.02-2.04) remained independently associated with abscess formation. 

Conclusion:  Alcohol abuse and delayed initiation of antibiotic treatment are risk factors for abscess formation in patients with cellulitis of the leg. Patients with these predictors must be monitored carefully for abscess formation.

Wiley

Prophylactic antibiotics for the prevention of cellulitis (erysipelas) of the leg: results of the U.K. Dermatology Clinical Trials Network’s PATCH II trial

2012

U.K Dermatology Clinical Trials Network's PATCH Trial Team

Background

Cellulitis (erysipelas) of the leg is a common, painful infection of the skin and underlying tissue. Repeat episodes are frequent, cause significant morbidity and result in high health service costs.

Objectives

To assess whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes.

Methods

Double-blind, randomized controlled trial including patients recently treated for an episode of leg cellulitis. Recruitment took place in 20 hospitals. Randomization was by computer-generated code, and treatments allocated by post from a central pharmacy. Participants were enrolled for a maximum of 3 years and received their randomized treatment for the first 6 months of this period.

Results

Participants (n = 123) were randomized (31% of target due to slow recruitment). The majority (79%) had suffered one episode of cellulitis on entry into the study. The primary outcome of time to recurrence of cellulitis included all randomized participants and was blinded to treatment allocation. The hazard ratio (HR) showed that treatment with penicillin reduced the risk of recurrence by 47% [HR 0·53, 95% confidence interval (CI) 0·26–1·07, P = 0·08]. In the penicillin V group 12/60 (20%) had a repeat episode compared with 21/63 (33%) in the placebo group. This equates to a number needed to treat (NNT) of eight participants in order to prevent one repeat episode of cellulitis [95% CI NNT(harm) 48 to ∞ to NNT(benefit) 3]. We found no difference between the two groups in the number of participants with oedema, ulceration or related adverse events.

Conclusions

Although this trial was limited by slow recruitment, and the result failed to achieve statistical significance, it provides the best evidence available to date for the prevention of recurrence of this debilitating condition.

Complete article:  NIH