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Maher E, Anokhin A. Bacterial Skin and Soft Tissue Infections in Older Adults. Clin Geriatr Med 2024; 40:117-130. [PMID: 38000856 DOI: 10.1016/j.cger.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
This article focuses on bacterial infections that commonly affect geriatric patients. The elderly population is at a higher risk of contracting bacterial infections due to weakened immune systems and comorbidities. The article explores the cause, pathogenesis, clinical manifestations, and treatment options of these infections. Additionally, antibiotic resistance is a growing concern in the treatment of bacterial infections. The article highlights the importance of preventing these infections through proper hygiene and wound care. This article aims to provide an understanding of bacterial infections in geriatric patients and inform health-care providers on the most effective ways to manage and prevent these infections.
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Affiliation(s)
- Eamonn Maher
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 1-400, Minneapolis, MN 55455, USA.
| | - Anya Anokhin
- University of Missouri, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 1-400, Minneapolis, MN 55455, USA
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Bogdanov I, Darlenski R, Hristakieva E, Manuelyan K. The rash that presents as a vesiculobullous eruption. Clin Dermatol 2020; 38:19-34. [DOI: 10.1016/j.clindermatol.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Yang SS, Chandran NS, Huang JX, Tan KB, Aw DCW. A Fatal Case of "Bullous Erysipelas-like" Pseudomonas Vasculitis. Indian J Dermatol 2016; 61:120. [PMID: 26955132 PMCID: PMC4763643 DOI: 10.4103/0019-5154.174095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Erysipelas is a generally benign superficial bacterial skin infection, and its bullous form constitutes a rare and more severe variant. We describe the first and fatal case of “bullous erysipelas-like” septic vasculitis due to Pseudomonas bacteremi. A 69-year-old Chinese man presenting with diarrhea and septic shock initially began to rapidly develop sharply defined erythematous plaques with non-hemorrhagic bullae over his lower limbs. Culture of the aspirate from the bullae was positive for Pseudomonas aeruginosa. This was also consistent with his blood cultures showing Pseudomonas bacteremia. Histology of the skin lesion showed microthrombi and neutrophilic infiltrates in blood vessels with Gram-negative bacilli extruding from the vessel walls, characteristic of septic vasculitis. The bullous erysipelas-like lesions seen in this patient represents a rare manifestation of both septic vasculitis and Pseudomonas infection.
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Affiliation(s)
- Sam Shiyao Yang
- Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia
| | - Nisha Suyien Chandran
- Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia
| | - Jing Xiang Huang
- Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Asia
| | - Kong-Bing Tan
- Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Asia
| | - Derrick Chen-Wee Aw
- Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia
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Linke M, Booken N. Risikofaktoren für ein vermindertes Ansprechen in der Behandlung des Erysipels. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12575_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Miriam Linke
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim
| | - Nina Booken
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim
- Dermatologikum Hamburg
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Linke M, Booken N. Risk factors associated with a reduced response in the treatment of erysipelas. J Dtsch Dermatol Ges 2015; 13:217-25. [PMID: 25706926 DOI: 10.1111/ddg.12575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In most cases, erysipelas may be adequately treated using first-line antibiotic therapy. However, clinicians are sometimes confronted with complicated cases, in which patients do not respond to initial antibiotic therapy. The objective of this study was to identify risk factors associated with a reduced response to antibiotic therapy and, thus, a more complicated disease course. PATIENTS AND METHODS We retrospectively analyzed the clinical course of 98 patients with erysipelas treated with standard antibiotic therapy. Patient groups showing different therapeutic responses were compared with respect to clinical data, medical history, and laboratory parameters. RESULTS Patients with bullous or hemorrhagic erysipelas (p = 0.0008), stasis dermatitis (p = 0.01) or chronic venous insufficiency (p = 0.0004) showed a significantly reduced response to initial therapy with cefuroxime or clindamycin, respectively. Furthermore, the response to initial therapy significantly depended on C-reactive protein (p = 0.007) and neutrophil (p = 0.02) levels. CONCLUSION In erysipelas patients with clinical complications, abnormal laboratory parameters or preexisting local skin damage, an intensified antibiotic regimen should be considered.
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Affiliation(s)
- Miriam Linke
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Germany
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Lower limb cellulitis and its mimics. J Am Acad Dermatol 2012; 67:163.e1-12; quiz 175-6. [DOI: 10.1016/j.jaad.2012.03.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/28/2012] [Accepted: 03/29/2012] [Indexed: 12/17/2022]
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Turrentine JE, Brown AJ, Davis LS. Leg swelling, erythema, and bullae in a 6-year-old girl with chronic lymphatic insufficiency. Pediatr Dermatol 2011; 28:189-90. [PMID: 21504449 DOI: 10.1111/j.1525-1470.2011.01394.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Krasagakis K, Samonis G, Valachis A, Maniatakis P, Evangelou G, Tosca A. Local complications of erysipelas: a study of associated risk factors. Clin Exp Dermatol 2010; 36:351-4. [PMID: 21198795 DOI: 10.1111/j.1365-2230.2010.03978.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local complications of erysipelas include haemorrhagic, bullous, abscessing and necrotic lesions. The risk factors predisposing patients to local complications are not fully known. AIM To examine local complications of erysipelas and to identify possible risk factors predisposing to their appearance. METHODS Medical records from all patients hospitalized with complications of erysipelas (purpura, bullae, abscesses and necrosis), admitted to the University Hospital of Heraklion between 1994 and 2002, were retrospectively studied. Clinical and laboratory data were compared with those from patients with erysipelas without local complications. RESULTS In total, 145 patients were analysed, of whom 46 had local disease complications. Using bivariate analysis, the factors significantly associated with disease complications were found to be age ≥ 51 years, obesity, longer duration of local symptoms, and fever on admission. During hospitalization, increased C-reactive protein level, isolation of pathogens, longer duration of fever and/or presence of leucocytosis, absence of response to initial antibiotic therapy, and longer length of hospitalization were also associated with complications in the bivariate analysis. However, in the multivariate analysis, obesity (OR 4.489, 95% CI 1.719-11.725, P = 0.002) was the only independent factor associated with complicated erysipelas. CONCLUSIONS This study found obesity to be an independent risk factor for local complications, of erysipelas. Hence, obese patients with erysipelas are prone to complications, and should be carefully evaluated because of the potential severity of disease and the increased risk of failure of empirical antimicrobial therapy.
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Affiliation(s)
- K Krasagakis
- Department of Dermatology, University Hospital of Heraklion, Heraklion, Greece.
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Aragüés M, González-Arriba A. [Primary cutaneous infections due to Staphylococcus and Streptococcus]. ACTAS DERMO-SIFILIOGRAFICAS 2007; 98 Suppl 1:4-14. [PMID: 18093494 DOI: 10.1016/s0001-7310(07)70176-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Pyodermitis constitutes a very important chapter in dermatological practice. Its pathogenesis, in special the one caused by S. aureus, has improved due to the knowledge of the role developed by the host defensins, quorum-sensing signaling and the Panton-Valentine leucocidin gene among others. As well, exfoliative toxins and enterotoxins responsible for the staphylococal scalded skin syndrome (SSSS) and toxic shock syndrome, respectively, have been cloned. Also, it has been seen that bullous impetigo, SSSS and pemphigus foliaceus share a common target: desmoglein-1. The Panton-Valentine leucocidin gene has been related to the appearance of abscesses, necrotic cutaneous lesions and furuncles in young persons caused by meticillin resistant S. aureus, with its epidemiological implications. Finally, some atypical forms of erysipelas suppose a diagnostic challenge for the dermatologist.
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Affiliation(s)
- M Aragüés
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España.
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García-Río I, Pérez-Gala S, Aragüés M, Fernández-Herrera J, Fraga J, García-Díez A. Sweet's syndrome on the area of postmastectomy lymphoedema. J Eur Acad Dermatol Venereol 2006; 20:401-5. [PMID: 16643136 DOI: 10.1111/j.1468-3083.2006.01460.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sweet's syndrome (SS) has been reported in association with many conditions, including malignancy, infections, autoimmune disorders, pregnancy and drugs. MATERIALS AND METHODS We reviewed patients with SS-like lesions on the lymphoedema area seen in our department. Clinical manifestations, histopathologic characteristics, treatment and outcome data were recorded and analysed. RESULTS We report seven women with a history of surgery for breast cancer with axillary lymphadenectomy. Six of them were on tamoxifen. All of them had various lesions consistent with SS localized predominantly on the limb affected by the postmastectomy lymphoedema, and on the ipsilateral chest, trunk and back. One of them presented bullous lesions. Three of the cases underwent spontaneous remission, two resolved with antibiotic therapy, one healed with corticosteroids, and one with corticosteroids plus antibiotic. CONCLUSIONS Erythematous tender plaques on the area of postmastectomy lymphoedema could be considered an unusual manifestation of Sweet's syndrome. We have found only three similar cases in the literature. Although it is difficult to elucidate the pathogenesis of this entity, it has been suggested that it could be due to immune surveillance impairment.
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Affiliation(s)
- I García-Río
- Department of Dermatology, Hospital de La Princesa, Madrid, Spain
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Krasagakis K, Samonis G, Maniatakis P, Georgala S, Tosca A. Bullous Erysipelas: Clinical Presentation, Staphylococcal Involvement and Methicillin Resistance. Dermatology 2006; 212:31-5. [PMID: 16319471 DOI: 10.1159/000089019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Accepted: 04/23/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin. Bullous erysipelas represents a severe form of the disease. OBJECTIVE To evaluate the clinical and microbiological characteristics and treatment of bullous erysipelas. METHODS Patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, University Hospital of Heraklion, Crete, Greece, between the years 1996 and 2001 were retrospectively studied. RESULTS Fourteen patients (11 women, 3 men) with bullous erysipelas were evaluated. The lesions were located on the legs and face in 9 and 4 patients, respectively. The median duration of disease before hospital admission was 4 days. Eight patients had fever at presentation. Local trauma and various lesions were common causes for pathogen entry. The initial empirical antibiotic treatment included intravenous beta-lactams and was modified according to the sensitivities of the isolated strains. Staphylococcus aureus was isolated from 7 (50%), while S. warneri, Streptococcus pyogenes and Escherichia coli grew from the lesions of 3 other patients. Six out of 7 S. aureus strains were methicillin resistant (MRSA) but susceptible to several other non-beta-lactam antibiotics such as quinolones, vancomycin, rifampicin and trimethoprim/sulfamethoxazole. CONCLUSION Our findings suggest that S. aureus is frequently involved in and probably contributes in synergy with beta-hemolytic streptococci to the complicated course of bullous erysipelas. The frequency of MRSA isolation suggests that beta-lactam antibiotics may not be sufficient for the treatment of bullous erysipelas anymore, at least in areas with a high incidence of MRSA strains. The role of other classes of antibiotics providing adequate coverage for MRSA has to be evaluated in prospective clinical trials.
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Roujeau JC, Sigurgeirsson B, Korting HC, Kerl H, Paul C. Chronic dermatomycoses of the foot as risk factors for acute bacterial cellulitis of the leg: a case-control study. Dermatology 2005; 209:301-7. [PMID: 15539893 DOI: 10.1159/000080853] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Accepted: 08/05/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the role of foot dermatomycosis (tinea pedis and onychomycosis) and other candidate risk factors in the development of acute bacterial cellulitis of the leg. METHODS A case-control study, including 243 patients (cases) with acute bacterial cellulitis of the leg and 467 controls, 2 per case, individually matched for gender, age (+/-5 years), hospital and admission date (+/-2 months). RESULTS Overall, mycology-proven foot dermatomycosis was a significant risk factor for acute bacterial cellulitis (odds ratio, OR: 2.4; p < 0.001), as were tinea pedis interdigitalis (OR: 3.2; p < 0.001), tinea pedis plantaris (OR: 1.7; p = 0.005) and onychomycosis (OR: 2.2; p < 0.001) individually. Other risk factors included: disruption of the cutaneous barrier, history of bacterial cellulitis, chronic venous insufficiency and leg oedema. CONCLUSIONS Tinea pedis and onychomycosis were found to be significant risk factors for acute bacterial cellulitis of the leg that are readily amenable to treatment with effective pharmacological therapy.
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Musette P, Benichou J, Noblesse I, Hellot MF, Carvalho P, Young P, Levesque H, Courtois H, Caron F, Lauret P, Joly P. Determinants of severity for superficial cellutitis (erysipelas) of the leg: a retrospective study. Eur J Intern Med 2004; 15:446-450. [PMID: 15581749 DOI: 10.1016/j.ejim.2004.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Revised: 06/07/2004] [Accepted: 06/17/2004] [Indexed: 11/18/2022]
Abstract
BACKGROUND: Superficial cellulitis (erysipelas) of the leg is a frequent infectious disease with a favorable outcome, whereas some patients present a serious disease. The determinants of severity for superficial cellulitis (erysipelas) of the leg have not yet been clearly established. In order to determine the characteristics of patients presenting with severe superficial cellulitis of the leg, we analyzed patients with favorable and unfavorable outcome. METHODS: The records of 167 patients referred to Rouen University Hospital for non-superficial cellulitis of the leg were analyzed. Two severity groups of patients were retrospectively defined. Patients in the severe group either died secondary to infection during hospital stay or were hospitalized for a duration at least equal to the 90th percentile (i.e., >21 days of hospitalization). The remaining patients were considered as presenting with non-severe cellulitis. Potential determinants of severity were analyzed by univariate and multivariate analysis based on logistic regression. RESULTS: From univariate analysis, the following general factors were positively associated with severity: advanced age, arterial hypertension, diabetes mellitus, elevated leukocytosis, and elevated neutrophilia. The local factors associated with severity were ulcer of the leg and arteriosclerosis obliterans of the leg. From multivariate analysis, only age (P=0.004), diabetes mellitus (P=0.01), and leukocytosis (P=0.04) appeared to be independently associated with severity. A close to significant association was also found with arteriosclerosis obliterans of the leg (P=0.07). Whereas general complications occurred more frequently in the severe group, no such difference was observed for local complications. CONCLUSIONS: Determinants of severity for superficial cellulitis of the leg include high age and associated medical conditions. Aged patients and patients with diabetes mellitus, elevated leukocytosis, or possibly arteriosclerosis obliterans of the leg should preferably be hospitalized for specific care of associated conditions to avoid the occurrence of general complications.
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Affiliation(s)
- P Musette
- Department of Dermatology and INSERM Unit 539, Charles Nicolle University Hospital, 1 rue de Germont 76031, Rouen, France
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Okajima RMO, Freitas THPD, Zaitz C. Estudo clínico de 35 pacientes com diagnóstico de erisipela internados no Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. An Bras Dermatol 2004. [DOI: 10.1590/s0365-05962004000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: Erisipela e celulite são infecções cutâneas freqüentes. OBJETIVOS: Com o objetivo de avaliar incidência, fatores de risco, principais complicações, esquemas terapêuticos utilizados e evolução. MÉTODOS: Foram estudados 35 pacientes com diagnóstico de erisipela internados nas enfermarias do Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo no período de abril a agosto de 2002. RESULTADOS: A incidência de pacientes com diagnóstico de erisipela no período estudado foi de 0,87%. O fator de risco local mais encontrado foi o linfedema, seguido por episódios prévios de erisipela. Dos fatores de risco gerais, aqueles que comprometem a imunidade, como diabetes mellitus, etilismo e neoplasias, foram os mais observados em associação ao quadro de infecção dermatológica. Sinais inflamatórios locais foram encontrados em 97,8% dos casos. Verificaram-se quatro casos com complicações: necrose, abscesso, trombose venosa profunda e septicemia. A evolução dos pacientes foi satisfatória em mais de 97% dos casos. CONCLUSÕES: O tratamento com penicilina cristalina foi associado ao menor número de complicações (p<0,05) e ao menor custo (p<0,05), e a associação de anticoagulantes à terapia evidenciou menor incidência de complicações (p<0,05).
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Affiliation(s)
| | | | - Clarisse Zaitz
- Santa Casa de São Paulo; Santa Casa de Misericórdia de São Paulo
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Carratalà J, Rosón B, Fernández-Sabé N, Shaw E, del Rio O, Rivera A, Gudiol F. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis 2003; 22:151-7. [PMID: 12649712 DOI: 10.1007/s10096-003-0902-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to analyze medical outcomes, including risks for complications and mortality, in 332 adult patients hospitalized for cellulitis. The infection was documented microbiologically in 128 cases (39%). Staphylococcus aureus (46 cases) and Streptococcus pyogenes (22 cases) were the most frequent causative pathogens. Overall, 63 patients (19%) were discharged early (< or =4 days) and 166 patients (50%) were hospitalized for more than 4 days without developing any complications. One hundred three patients (31%) had one or more complications or died. Of these, 78 required surgical debridement, 10 required plastic surgery, 7 underwent amputation, and 15 had shock on presentation. When comparing the three study groups (patients discharged early, patients hospitalized for < or =4 days without complications, and patients who developed 1 or more complication or who died), patients who were discharged early (low risk) were more frequently female and were less likely to have multiple comorbid conditions, hypoalbuminemia, renal insufficiency, and/or cutaneous necrosis at presentation. Overall mortality (<30 days) was 5% (16/332 patients). Factors associated with death were male sex, presence of multiple comorbid conditions, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency, shock, and Pseudomonas aeruginosa cellulitis. These findings can be used to stratify patients with acute cellulitis according to risks for complications and mortality and may be helpful when deciding the most appropriate means of care, i.e. outpatient treatment or hospitalization.
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Affiliation(s)
- J Carratalà
- Infectious Disease Service, Hospital de Bellvitge, University of Barcelona, Feixa Llarga sn, 08907, LHospitalet, Barcelona, Spain.
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