Clinical characteristics of patients with lower limb cellulitis and antibiotic usage in Hospital Kuala Lumpur: a 7-year retrospective study

• Published in: International journal of dermatology Vol. 55; no. 1; pp. 30 - 35
• Main Authors: Ch'ng, Chin Chwen, Johar, Asmah
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.01.2016
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Cellulitis - diagnosis; Cellulitis - drug therapy; Cellulitis - epidemiology; Cohort Studies; Female; Follow-Up Studies; Hospitals, Urban; Humans; Lower Extremity; Malaysia; Male; Microbial Sensitivity Tests; Middle Aged; Pseudomonas; Recurrence; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Treatment Outcome; Young Adult
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1111/ijd.12850

Background Cellulitis commonly involved lower limbs. This study was carried out to determine the demography, clinical characteristics, risk factors, microbiological aspects, and antibiotics usage in this group of patients in Hospital Kuala Lumpur. Methods A total of one hundred and twenty four patients with lower limb cellulitis treated in the Department of Dermatology, Hospital Kuala Lumpur, between January 2008 and May 2013 were included in this study. Results There were 70 male and 54 female patients, aged between 13 and 87 years (mean 57.23±12.854). Thirty‐one of them (25%) had recurrent cellulitis. Fifty‐seven (46%) had fever at presentation, 55 (44.4%) had bullous cellulitis. The top risk factors identified were toe web intertrigo (n = 79, 63.7%), hypertension (n=76, 61.3%), obesity (n = 55, 44.4%), and diabetes (n = 55, 44.4%). However, only toe web intertrigo (p = 0.003), peripheral vascular disease (p = 0.01), and varicose veins (p = 0.02) were significantly higher in recurrent cellulitis. Thirty patients (24.2%) were complicated with lipodermatosclerosis, and six (4.8%) had lymphostasis verrucosa cutis. Skin swab cultures were positive in 54 (43.5%) patients, and Pseudomonas sp. was the most frequently identified organism. Mean number of antibiotics given for one episode of cellulitis was 1.7±1. The antibiotics most given were cloxacillin (n=57, 46%) and other penicillins (n = 71, 57%), followed by cephalosporins (n = 40, 32%). Conclusion Identifying clinical characteristics of those at risk may help to prevent recurrence of cellulitis and long‐term complications.