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Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care.

ABSTRACT: Importance:Cellulitis is a commonly occurring skin and soft tissue infection and one of the most frequently seen dermatological diseases in the intensive care unit (ICU). However, clinical characteristics of patients with cellulitis requiring intensive care treatment are poorly defined. Necrotizing fasciitis is often confused for cellulitis at initial presentation and is considered to be more severe and thus has previously been described in more detail. Objective:To describe the clinical presentation and outcomes of patients with ICU-necessitating cellulitis and to compare them with patients with necrotizing fasciitis. Design, Setting, and Participants:This prospective cohort study includes all ICU admissions from 2 tertiary hospitals in the Netherlands. Of 2562 sepsis admissions, 101 had possible, probable, or definite cellulitis or soft tissue infections. Retrospective review identified severe cellulitis was the reason for ICU admission in 23 patients, necrotizing fasciitis in 31 patients, and other diagnoses in 47 patients. Main Outcomes and Measures:Patient and disease characteristics, cultured pathogens, lengths of stay, and short-term and long-term mortality. Results:Overall, 54 patients with cellulitis (n?=?23; mean [SD] age, 57.2 [17.7] years) or necrotizing fasciitis (n?=?31; mean [SD] age, 54.3 [13.5]) were included in this study. Patients with cellulitis were found to be less severely ill than patients with necrotizing fasciitis. This is reflected in rates of shock (7 [30.4%] vs 19 [61.3%]; P?=?.03), need for mechanical ventilation (12 [52.2%] vs 19 [93.5%]; P?=?.003) and slightly lower mean Sequential Organ Failure Assessment scores (8 vs 10; P?=?.046). Median (interquartile range [IQR]) Acute Physiology and Chronic Health Evaluation IV scores did not differ significantly (82 [75-98] vs 76 [70-96]; P?=?.16). Patients with cellulitis had more chronic comorbidities than patients with necrotizing fasciitis (20 [87.0%] vs 17 [54.8%]; P?=?.02), especially cardiovascular insufficiencies (10 [43.5%] vs 4 [12.9%]; P?=?.02) and immunodeficiencies (9 [39.1%] vs 3 [9.7%]; P?=?.02). Among patients with cellulitis and patients with patients with necrotizing fasciitis, Staphylococcus aureus (10 [43.5%] vs 4 [12.9%]; P?=?.02), Streptococcus pyogenes (2 [8.7%] vs 19 [61.3%]; P??.99) and 90-day mortality rate (30.4% vs 22.6%; P?=?.54) were similar. Conclusions and Relevance:Patients with cellulitis patients are seldom admitted to the ICU. However, while these patients are less critically ill on admission than patients with necrotizing fasciitis, they have more chronic comorbidities and most notably similar short-term and long-term mortality. Trial Registration:clinicaltrials.gov Identifier: NCT01905033.

SUBMITTER: Cranendonk DR

PROVIDER: S-EPMC5817617 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care.

Cranendonk Duncan R DR van Vught Lonneke A LA Wiewel Maryse A MA Cremer Olaf L OL Horn Janneke J Bonten Marc J MJ Schultz Marcus J MJ van der Poll Tom T Wiersinga W Joost WJ

JAMA dermatology 20170601 6

<h4>Importance</h4>Cellulitis is a commonly occurring skin and soft tissue infection and one of the most frequently seen dermatological diseases in the intensive care unit (ICU). However, clinical characteristics of patients with cellulitis requiring intensive care treatment are poorly defined. Necrotizing fasciitis is often confused for cellulitis at initial presentation and is considered to be more severe and thus has previously been described in more detail.<h4>Objective</h4>To describe the c ...[more]

PMID: 28296993

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Project description:Contemporary information on mechanical ventilation (MV) use in emerging countries is limited. Moreover, most epidemiological studies on ventilatory support were carried out before significant developments, such as lung protective ventilation or broader application of non-invasive ventilation (NIV). We aimed to evaluate the clinical characteristics, outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units (ICU).In a multicenter, prospective, cohort study, a total of 773 adult patients admitted to 45 ICUs over a two-month period requiring invasive ventilation or NIV for more than 24 hours were evaluated. Causes of ventilatory support, prior chronic health status and physiological data were assessed. Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure.Invasive MV and NIV were used as initial ventilatory support in 622 (80%) and 151 (20%) patients. Failure with subsequent intubation occurred in 54% of NIV patients. The main reasons for ventilatory support were pneumonia (27%), neurologic disorders (19%) and non-pulmonary sepsis (12%). ICU and hospital mortality rates were 34% and 42%. Using the Berlin definition, acute respiratory distress syndrome (ARDS) was diagnosed in 31% of the patients with a hospital mortality of 52%. In the multivariate analysis, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01 to 1.03), comorbidities (OR, 2.30; 95% CI, 1.28 to 3.17), associated organ failures (OR, 1.12; 95% CI, 1.05 to 1.20), moderate (OR, 1.92; 95% CI, 1.10 to 3.35) to severe ARDS (OR, 2.12; 95% CI, 1.01 to 4.41), cumulative fluid balance over the first 72 h of ICU (OR, 2.44; 95% CI, 1.39 to 4.28), higher lactate (OR, 1.78; 95% CI, 1.27 to 2.50), invasive MV (OR, 2.67; 95% CI, 1.32 to 5.39) and NIV failure (OR, 3.95; 95% CI, 1.74 to 8.99) were independently associated with hospital mortality. The predictors of NIV failure were the severity of associated organ dysfunctions (OR, 1.20; 95% CI, 1.05 to 1.34), ARDS (OR, 2.31; 95% CI, 1.10 to 4.82) and positive fluid balance (OR, 2.09; 95% CI, 1.02 to 4.30).Current mortality of ventilated patients in Brazil is elevated. Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting.ClinicalTrials.gov NCT01268410.

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Dataset Information

Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care.

Publications

Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care.

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