The effect of histopathologic analysis and tissue cultures on inpatient management of cellulitis: a randomized control trial.
Analysis
Biopsy
Cellulitis
Culture
Histopathologic
Inpatient
Management
Pseudocellulitis
Tissue
Journal
Archives of dermatological research
ISSN: 1432-069X
Titre abrégé: Arch Dermatol Res
Pays: Germany
ID NLM: 8000462
Informations de publication
Date de publication:
23 Jul 2024
23 Jul 2024
Historique:
received:
06
06
2024
accepted:
06
07
2024
revised:
01
07
2024
medline:
23
7
2024
pubmed:
23
7
2024
entrez:
23
7
2024
Statut:
epublish
Résumé
In the absence of a gold-standard diagnostic modality for cellulitis, sterile inflammatory disorders may be misdiagnosed as cellulitis. To determine the utility of skin biopsy and tissue culture for the diagnosis and management of patients admitted with a diagnosis of presumed cellulitis. Pilot single-blind parallel group randomized controlled clinical trial in 56 patients with a primary diagnosis of presumed cellulitis. In the intervention group only, skin biopsy and tissue culture results were made available to the primary care team to guide diagnosis and management. Length of hospital stay and antibiotic use were evaluated as outcome measures. Length of stay showed the greatest opportunity for further study as a primary outcome (intervention: 4, IQR (2-6) vs. control: 5 IQR (3-8) days; p = 0.124). The COVID-19 pandemic placed limitations on participant enrollment and study duration; in addition, data was collected from a single medical center. This study demonstrates that length of stay and anti-pseudomonal antibiotic de-escalation are endpoints that may be influenced by biopsy and tissue culture results in presumed cellulitis patients; these outcomes warrant further study.
Sections du résumé
BACKGROUND
BACKGROUND
In the absence of a gold-standard diagnostic modality for cellulitis, sterile inflammatory disorders may be misdiagnosed as cellulitis.
OBJECTIVE
OBJECTIVE
To determine the utility of skin biopsy and tissue culture for the diagnosis and management of patients admitted with a diagnosis of presumed cellulitis.
DESIGN
METHODS
Pilot single-blind parallel group randomized controlled clinical trial in 56 patients with a primary diagnosis of presumed cellulitis. In the intervention group only, skin biopsy and tissue culture results were made available to the primary care team to guide diagnosis and management. Length of hospital stay and antibiotic use were evaluated as outcome measures.
RESULTS
RESULTS
Length of stay showed the greatest opportunity for further study as a primary outcome (intervention: 4, IQR (2-6) vs. control: 5 IQR (3-8) days; p = 0.124).
LIMITATIONS
CONCLUSIONS
The COVID-19 pandemic placed limitations on participant enrollment and study duration; in addition, data was collected from a single medical center.
CONCLUSION
CONCLUSIONS
This study demonstrates that length of stay and anti-pseudomonal antibiotic de-escalation are endpoints that may be influenced by biopsy and tissue culture results in presumed cellulitis patients; these outcomes warrant further study.
Identifiants
pubmed: 39042316
doi: 10.1007/s00403-024-03224-5
pii: 10.1007/s00403-024-03224-5
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
482Subventions
Organisme : The Center for Clinical and Translational Science at The Ohio State University Wexner Medical Center
ID : Patient Safety Advancement Grant
Informations de copyright
© 2024. The Author(s).
Références
Raff AB, Kroshinsky D, Cellulitis (2016) A review. JAMA 316(3):325–337. https://doi.org/10.1001/jama.2016.8825
doi: 10.1001/jama.2016.8825
pubmed: 27434444
Peterson RA, Polgreen LA, Cavanaugh JE, Polgreen PM (2017) Increasing incidence, cost, and seasonality in patients hospitalized for cellulitis. Open Forum Infect Dis 4(1):ofx008. https://doi.org/10.1093/ofid/ofx008
doi: 10.1093/ofid/ofx008
pubmed: 28480281
pmcid: 5414024
Zhang M, Markova A, Harp J, Dusza S, Rosenbach M, Kaffenberger BH (2019) Dermatology-specific and all-cause 30-day and calendar-year readmissions and costs for dermatologic diseases from 2010 to 2014. J Am Acad Dermatol 81(3):740–748. https://doi.org/10.1016/j.jaad.2019.05.023
doi: 10.1016/j.jaad.2019.05.023
pubmed: 31102603
pmcid: 6698216
Levell NJ, Wingfield CG, Garioch JJ (2011) Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol 164(6):1326–1328. https://doi.org/10.1111/j.1365-2133.2011.10275.x
doi: 10.1111/j.1365-2133.2011.10275.x
pubmed: 21564054
Strazzula L, Cotliar J, Fox LP et al (2015) Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: a multi-institutional analysis. J Am Acad Dermatol 73(1):70–75. https://doi.org/10.1016/j.jaad.2014.11.012
doi: 10.1016/j.jaad.2014.11.012
pubmed: 26089048
Li DG, Xia FD, Khosravi H et al (2018) Outcomes of early Dermatology Consultation for inpatients diagnosed with Cellulitis. JAMA Dermatol 154(5):537–543. https://doi.org/10.1001/jamadermatol.2017.6197
doi: 10.1001/jamadermatol.2017.6197
pubmed: 29453874
pmcid: 5876861
Ko LN, Garza-Mayers AC, St John J et al (2018) Effect of Dermatology Consultation on outcomes for patients with presumed cellulitis: a Randomized Clinical Trial. JAMA Dermatol 154(5):529–536. https://doi.org/10.1001/jamadermatol.2017.6196
doi: 10.1001/jamadermatol.2017.6196
pubmed: 29453872
pmcid: 5876891
Gupta P, Tolliver S, Zhang M, Schumacher E, Kaffenberger BH (2020) Impact of dermatology and teledermatology consultations for patients admitted with cellulitis: a pilot study. J Am Acad Dermatol 82(2):513–515. https://doi.org/10.1016/j.jaad.2019.09.022
doi: 10.1016/j.jaad.2019.09.022
pubmed: 31557497
Wells A, Gupta P, Tian F, Adkins E, Kaffenberger B (2020) The effect of implementing teledermatology in patients presenting with cellulitis versus pseudocellulitis in an academic emergency department setting: a pilot study. J Clin Aesthet Dermatol 13(4):43–44
pubmed: 33144911
pmcid: 7605385
Korman AM, Kroshinsky D, Raff AB et al (2020) A survey-based study of diagnostic and treatment concordance in standardized cases of cellulitis and pseudocellulitis via teledermatology. J Am Acad Dermatol 82(5):1221–1223. https://doi.org/10.1016/j.jaad.2019.09.084
doi: 10.1016/j.jaad.2019.09.084
pubmed: 31626887
Kilburn SA, Featherstone P, Higgins B, Brindle R (2010) Interventions for cellulitis and erysipelas. Cochrane Database Syst Rev 2010(6):CD004299 Published 2010 Jun 16. https://doi.org/10.1002/14651858.CD004299.pub2
doi: 10.1002/14651858.CD004299.pub2
pubmed: 20556757
pmcid: 8693180
Johnson KE, Kiyatkin DE, An AT, Riedel S, Melendez J, Zenilman JM (2012) PCR offers no advantage over culture for microbiologic diagnosis in cellulitis. Infection 40(5):537–541. https://doi.org/10.1007/s15010-012-0289-7
doi: 10.1007/s15010-012-0289-7
pubmed: 22802097
pmcid: 4203696
Pallin DJ, Bry L, Dwyer RC et al (2016) Toward an objective diagnostic test for bacterial cellulitis. PLoS ONE 11(9):e0162947 Published 2016 Sep 22. https://doi.org/10.1371/journal.pone.0162947
doi: 10.1371/journal.pone.0162947
pubmed: 27656884
pmcid: 5033594
Toleman MS, Vipond IB, Brindle R, Specific PCR (2016) Bacterial culture, serology and pharyngeal sampling to enhance the aetiological diagnosis of cellulitis. J Med Microbiol 65(1):44–47. https://doi.org/10.1099/jmm.0.000191
doi: 10.1099/jmm.0.000191
pubmed: 26487664
Ly N, Goldenberg M, Korman AM et al (2022) A retrospective study of cellulitis outcomes in Ohio hospitals with or without access to dermatology residency programs. Int J Dermatol 61(1):e40–e42. https://doi.org/10.1111/ijd.15611
doi: 10.1111/ijd.15611
pubmed: 33900621
Brindle R, Williams OM, Davies P et al (2017) Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis. BMJ Open 7(3):e013260 Published 2017 Mar 17. https://doi.org/10.1136/bmjopen-2016-013260
doi: 10.1136/bmjopen-2016-013260
pubmed: 28314743
pmcid: 5372109