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Adherence to antibiotic guidelines for erysipelas or cellulitis is associated with a favorable outcome

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Abstract

Outside areas of S. aureus strains resistant to methicillin (MRSA) in the community, no studies showed a relationship between the treatment for erysipelas or cellulitis and the outcome. We aimed to measure the impact of an internal therapeutic protocol, based on national guidelines on patients’ outcome. This study was based on the dashboard of the infectious diseases department, which prospectively includes 28 parameters for all admitted patients. We included community-acquired erysipelas and cellulitis; exclusion criteria were abscesses at admission; ear, nose, throat, or dental cellulitis; pyomyositis; and length of stay ≤ 2 days. Adherence to guidelines was defined by the use of amoxicillin, amoxicillin/clavulanic acid, clindamycin, or pristinamycin, alone or in combination or successively. A poor outcome was defined by surgical procedure or intensive care requirement or death occurring after 5 days or more of antibiotic therapy. From July 2005 to June 2017, 630 cases of erysipelas or cellulitis were included. Blood cultures performed in 567 patients (90%) were positive in 39 cases (6.9%). Adherence rate to guidelines was 65% (410 cases). A poor outcome was recorded in 54 (8.5%) patients, less frequently in case of adherence to guidelines: 26/410 (6.3%) vs 28/220 (12.7%), p = 0.007. In logistic regression analysis, two risk factors were associated with a poor outcome: peripheral arterial disease, AOR 4.80 (2.20–10.49); and bacteremia, AOR 5.21 (2.31–11.76), while guideline adherence was the only modifiable protective factor, OR 0.48 (0.26–0.89). In erysipelas and cellulitis, adherence to guidelines was associated with a favorable outcome.

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Authors and Affiliations

  1. Infectiologie, Hôpital de l’Archet, Centre Hospitalier Universitaire de Nice, Nice, France

    Camille Klotz, Johan Courjon, Céline Michelangeli, Elisa Demonchy & Pierre-Marie Roger

  2. Faculté de Médecine, Université de Nice Sophia-Antipolis, Nice, France

    Johan Courjon, Raymond Ruimy & Pierre-Marie Roger

  3. Bactériologie, Hôpital de l’Archet, Centre Hospitalier Universitaire de Nice, Nice, France

    Raymond Ruimy

  4. Groupe Elsan, Rue de la Boétie, 75008, Paris, France

    Pierre-Marie Roger

Authors
  1. Camille Klotz
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  2. Johan Courjon
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  3. Céline Michelangeli
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  4. Elisa Demonchy
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  5. Raymond Ruimy
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  6. Pierre-Marie Roger
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Correspondence to Camille Klotz.

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The authors declare that they have no conflict of interest.

Ethics approval

Observational studies do not require ethical approval in France. Antimicrobial stewardship is promoted by the French National Health Agency. Internal dashboard is declared to French Data Protection Authority, number 1430722.

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Patients or their relatives provided their written consent for digitization of their personal data for hospitalization purposes.

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Klotz, C., Courjon, J., Michelangeli, C. et al. Adherence to antibiotic guidelines for erysipelas or cellulitis is associated with a favorable outcome. Eur J Clin Microbiol Infect Dis 38, 703–709 (2019). https://doi.org/10.1007/s10096-019-03490-6

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  • DOI: https://doi.org/10.1007/s10096-019-03490-6

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