Predicting Outpatient Failure for Cellulitis

Written by Clay Smith

Spoon Feed
Tachypnea, chronic ulcers, prior MRSA colonization, and prior cellulitis in the past 12 months were all associated with an increased risk of oral antibiotic failure for treatment of non-purulent cellulitis.

Why does this matter?
At our institution, we are looking for ways to reduce admission, and cellulitis is a target illness.  This adds a few more items to the possible list of exclusions when considering whether it is safe to treat as an outpatient.

When PO antibiotics are more likely to fail
This was a retrospective study of patients presenting to the ED with non-purulent cellulitis.  They found 288 who failed oral antibiotics.  The risk factors for failure were respiratory rate >20 at triage (OR 6.31), chronic ulcers (OR 4.90), history of MRSA colonization or infection (OR 4.83), and cellulitis in the past 12 months (OR 2.23).  Surprisingly, diabetes and chronic kidney disease were not associated with increased risk.

Source
Predictors of Oral Antibiotic Treatment Failure for Non-Purulent Skin and Soft Tissue Infections in the Emergency Department.  Acad Emerg Med. 2018 Jun 5. doi: 10.1111/acem.13492. [Epub ahead of print]
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Reviewed by Thomas Davis

Another Spoonful
EM Lit of Note has a review of this article worth reading as well.

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