Assessment of the risk factors of recurrent lower extremity cellulits and the effect of clinical and laboratory findings on treatment response

Yıl 2019, Cilt: 11 Sayı: 4, 477 - 483, 01.12.2019

Sudem Mahmutoğlu Çolak Fatma Yılmaz Karadağ Mustafa Haluk Vahaboğlu

https://doi.org/10.21601/ortadogutipdergisi.485764

Öz

Aim: To determine the risk factors of patients followed with recurrent lower extremity cellulitis and to find out the effect of clinical and laboratory findings on treatment response.
Material and Method: This retrospective study was conducted between September 2011 and June 2016 at Infectious Disease clinic of Istanbul Medeniyet University Education and Research Hospital and all hospitalized patients diagnosed as lower extremity cellulitis, aged between 18-91, were involved. Data of all patients was determined by searching patients files and epicrisis. Demographic features, accompanying disease, predisposing factors, last cellulitis attack and its features, patients symptoms at hospitalization day, physical examination findings, laboratory values, given antibiotics and control laboratory values at 72 h were investigated.
Results: Totally 93 patients with a diagnosis of lower extremity cellulitis, 40 (43%) of whom had recurrent cellulitis were included in the study, Patients with a history of recurrent cellulitis compared with patients with first attack. Patients having tinea pedis (p=0.038) and diagnosed as coronary artery disease (0.015) were found statistically significant for recurrent cellulitis. Patients white blood cell (WBC), c-reactive protein (CRP) value at hospitalization day and control laboratory values at 72 h were compared and no statistically significant data obtained. Treatment change has done after 48-72 hours on 28 of patients whom receiving antibiotherapy with the idea of treatment failure. Between patients considering unresponsiveness to antibiotic therapy and undergone treatment change, statistically significant differences were detected for WBC (p=0.016) and CRP (0.024) value at the day of hospitalization, control WBC (0.01) and CRP (0.001) value at 72 h. Similarly, statistically significant results for the patients had severe pain in lower extremity at the day of hospitalization were obtained (p=0.019).
Conclusion: Patients having tinea pedis and accompanying coronary artery disease are more probable to new cellulitis attack whose had a history of recurrent lower extremity cellulitis. The risk would be more through nonresponder patients whom WBC and CRP value were high at hospitalization day and the continuation of high WBC and CRP values at 72 h were detected. In patients undergone treatment change, statistically significant differences were detected between patients have severe pain in lower extremity at the day of hospitalization and patients not.

Anahtar Kelimeler

cellulitis, recurrent cellulitis, erysipelas, lower extremity, risk factors

Rekürren alt ekstremite selülitlerinde risk faktörlerinin değerlendirilmesi ve laboratuvar ile klinik bulguların tedavi yanıtına etkisi

Öz

Amaç: Bu çalışmada rekürren alt ekstremite selüliti nedeniyle takip edilen hastalarda risk faktörlerinin değerlendirilmesi ve laboratuvar bulguları ile klinik bulguların tedavi yanıtı üzerine etkisinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Eylül 2011 ve Ekim 2015 tarihleri arasında Sağlık Bakanlığı İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Enfeksiyon Hastalıkları kliniğinde yatırılarak takip edilen alt ekstremite selüliti tanısı almış 18 ile 91 yaş arası tüm hastalar çalışmaya alınmıştır. Hasta dosyaları ve epikrizleri taranarak hasta bilgilerine ulaşılmıştır. Hastaların demografik özellikleri, eşlik eden hastalıkları, predispozan faktörleri, en son geçirdiği selülit atağı ve özellikleri, başvuru semptomları, fizik muayene bulguları, laboratuvar değerleri, verilen antibiyotik tedavisi, 72.saatteki kontrol laboratuvar değerleri incelenmiştir.
Bulgular: Bu çalışmaya 93 hasta dâhil edilmiştir ve 40’ında (%43) rekürrens saptanmıştır. Rekürrens öyküsü olan ve olmayan hastalar karşılaştırılmış; hastalarda risk faktörü olarak tinea pedisin (p=0.038) olması ve eşlik eden koroner arter hastalığının (p=0,015) olması rekürrens yönünden istatistiksel olarak anlamlı saptanmıştır. Rekürrens öyküsü olan ve olmayan hastaların başvuru lökosit sayısı (BK), CRP değerleri ile 72. saatteki laboratuvar değerleri karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmamıştır. Antibiyoterapi başlanan hastaların 28’inde tedavi yanıtsızlığı düşünülerek 48-72 saat sonra antibiyoterapi değişimi yapılmıştır. Antibiyoterapi değişimi ile laboratuvar bulguları karşılaştırıldığında; yatış BK (p=0,016), yatış CRP (p=0,024), 72. saatteki BK (p=0,01) ve 72. saatteki CRP (p=0,001) değerlerinde istatistiksel anlamlılık tespit edilmiştir. Aynı zamanda başvuru esnasında alt ekstremitede şiddetli ağrı yakınması olan hastalar ile antibiyotik tedavi değişim gerekliliği arasında ilişki olduğu gözlenmiştir (p=0,019).
Sonuç: Rekürren alt ekstremite selüliti öyküsü olan hastalarda eşlik eden tinea pedis ve koroner arter hastalığının olması yeni bir selülit atağı için risk faktörü olarak değerlendirilebilir. Başvuru esnasında yüksek BK ve CRP değeri olan ve 72. saatteki kontrol değerlerinin halen yüksek seyrettiği hastalarda tedavi yanıtsızlık riskinin daha fazla olacağı düşünülebilir. Başvuru esnasında şiddetli ağrı öyküsü olan hastalarda olmayanlara göre tedavi değişikliği ihtiyacı olma ihtimali daha fazladır.

Anahtar Kelimeler

selülit, rekürren selülit, erizipel, alt ekstremite, risk faktörleri

Kaynakça

• Bennett JE, Dolin R, Blaser MJ. Principles and practice of infectious diseases. 2014.
• Bisno AL, Stevens DL. Streptococcal infections of skin and softtissues. N Engl J Med. 1996;334(4):240–246.
• Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections. Clin Infect Dis. 2005;41(10):1373–406.
• Pasternak M, Swartz M. Cellulitis and subcutaneous tissue infections. Mandell Douglas and Bennetts Principles and Practice of Infectious Diseases, 6th ed. Ersevier Churchill Livingstone: Philadelphia; 2005.
• Chlebicki MP, Oh CC. Recurrent cellulitis: risk factors, etiology, pathogenesis and treatment. Curr Infect Dis Rep. 2014;16(9):1–8.
• Carratala J, Roson B, Fernandez-Sabe N, Shaw E, Del Rio O, Rivera A, et al. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis. 2003;22(3):151–7.
• Dupuy A, Benchikhi H, Roujeau JC, Bernard P, Vaillant L, Chosidow O, et al. Risk factors for erysipelas of the leg cellulitis: case-control study. BMJ. 1999;318(7198):1591–4.
• Cox N. Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up. Br J Dermatol. 2006;155(5):947–50.
• McNamara DR, Tleyjeh IM, Berbari EF, Lahr BD, Martinez J, Mirzoyev SA, et al. A predictive model of recurrent low erextremity cellulitis in a population-based cohort. Arch Intern Med. 2007;167(7):709–15.
• Baddour LM, Bisno AL. Recurrent cellulitis after saphenous venectomy for coronary bypass surgery. Ann Intern Med. 1982;97(4):493–6.
• Dan M, Heller K, Shapira I, Shibolet S, Vidne B. Incidence of erysipelas following venectomy for coronary artery bypass surgery. Infect. 1987;15(2):107–8.
• Mokni M, Dupuy A, Denguezli M, Dhaoui R, Bouassida S, Amri M, et al. Risk factors for erysipelas of the leg in Tunisia: a multicenter case control study. Dermatology. 2006;212(2):108–12.
• Lewis SD, Peter GS, Gomez-Marin O, Bisno AL. Risk factors for recurrent low erextremity cellulitis in a US Veterans Medical Center population. Am J Med Sci. 2006;332(6):304–7.
• Pavlotsky F, Amrani S, Trau H. Recurrent erysipelas: risk factors. J Dtsch Dermatol Ges. 2004;2(2):89–95.
• Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the IDSA. Clin Infect Dis. 2014;59(2):e10–e52.
• Esposito S, Bassetti M, Bonnet E, Bouza E, Chan M, De Simone G, et al. Hot topics in the diagnosis and management of skin and soft tissue infections. Int J Antimicrob Agents. 2016.
• Karppelin M, Siljander T, Vuopio-Varkila J, Kere J, Huhtala H, Vuento R, et al. Factors predisposing to acute and recurrent bacterial nonnecrotizing cellulitis in hospitalized patients: a prospective case control study. Clin Microbiol Infect. 2010;16(6):729–34.
• Karppelin M, Siljander T, Aittoniemi J, Hurme M, Huttunen R, Huhtala H, Kere J, Vuopio J, Syrjanen J. Predictors of recurrent cellulitis in five years. Clinical risk factors and the role of PTX3 and CRP. J Infect. 2015;70(5):467-73
• Björnsdóttir S, Gottfredsson M, Thórisdóttir AS, Gunnarsson GB, Ríkardsdóttir H, Kristjánsson M, et al. Risk factors for acute cellulitis of the lower limb: a prospective case control study. Clin Infect Dis. 2005;41(10):1416–22.
• Patlotsky F, Amrani S, Trau H. Recurrent erysipelas: risk factors. J Dtsch Dermatol Ges. 2004;2(2):89-95
• Dupuy A, Benchikhi H, Roujeau JC, et al. Risk factors for erysipelas of the leg cellulitis: case control study. BMJ. 1999;318(7198)1591-4.
• Stoberl C. The importance of local factors in recurrent erysipelas. Z Hautkr. 1985;60(9):712-23.
• Tay EY, Fook-Chong S, Oh CC, Thirumoorthy T, Pang SM, Lee HY. Cellulitis Recurrence Score: A tool for predicting recurrence of lower limb cellulitis. J Am Acad Dermatol. 2015;72(1):140–5.
• Inghammar M, Rasmussen M. Recurrent erysipelas risk factors and clinical presentation. BMC Infect Dis. 2014;14:270.
• Ilkit M, Tanir F, Hazar S, Gümüşay T, Akbab M. Epidemiology of tinea pedis and toe nail tinea unguium in worshippers in the mosques in Adana, Turkey. J Dermatol. 2005;32(9):698-704.