Clinical and microbiological characteristics of purulent and non-purulent cellulitis in hospitalized Taiwanese adults in the era of community-associated methicillin-resistant Staphylococcus aureus

Persistent Link:
http://hdl.handle.net/10150/610291
Title:
Clinical and microbiological characteristics of purulent and non-purulent cellulitis in hospitalized Taiwanese adults in the era of community-associated methicillin-resistant Staphylococcus aureus
Author:
Lee, Chun-Yuan; Tsai, Hung-Chin; Kunin, Calvin M.; Lee, Susan SJ; Chen, Yao-Shen
Affiliation:
Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital; Faculty of Medicine, School of Medicine, National Yang-Ming University; Department of Internal Medicine (CMK), Ohio State University and the University of Arizona; Graduate Institute of Science Education and Environmental Education, Nathional Kaohsiung Normal University; University of Arizona
Issue Date:
2015
Publisher:
BioMed Central Ltd
Citation:
Lee et al. BMC Infectious Diseases (2015) 15:311 DOI 10.1186/s12879-015-1064-z
Journal:
BMC Infectious Diseases
Rights:
© 2015 Lee et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0)
Collection Information:
This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.
Abstract:
BACKGROUND: The risk factors, microbial etiology, differentiation, and clinical features of purulent and non-purulent cellulitis are not well defined in Taiwan. METHODS: We conducted a retrospective cohort study of hospitalized adults with cellulitis in Taiwan in 2013. The demographic characteristics, underlying diseases, clinical manifestations, laboratory and microbiological findings, treatments, and outcomes were compared for patients with purulent and non-purulent cellulitis. RESULTS: Of the 465 patients, 369 had non-purulent cellulitis and 96 had purulent cellulitis. The non-purulent group was significantly older (p = 0.001) and was more likely to have lower limb involvement (p < 0.001), tinea pedis (p = 0.003), stasis dermatitis (p = 0.025), a higher Charlson comorbidity score (p = 0.03), and recurrence at 6 months post-infection (p = 0.001) than the purulent group. The purulent group was more likely to have a wound (p < 0.001) and a longer hospital stay (p = 0.001) and duration of antimicrobial therapy (p = 0.003) than the non-purulent group. The etiological agent was identified in 35.5 % of the non-purulent cases, with β-hemolytic streptococci the most frequent cause (70.2 %). The etiological agent was identified in 83.3 % of the purulent cases, with Staphylococcus aureus the predominant pathogen (60 %): 50 % of these were methicillin-resistant S. aureus (MRSA). In multivariable analysis, purulent group (odds ratio (OR), 5.188; 95 % confidence interval (CI), 1.995-13.493; p = 0.001) was a positive predictor of MRSA. The prescribed antimicrobial agents were significantly different between the purulent and non-purulent groups, with penicillin the most frequently used antimicrobial agent in the non-purulent group (35.2 %), and oxacillin the most frequent in the purulent group (39.6 %). The appropriate antimicrobial agent was more frequently prescribed in the non-purulent group than in the purulent group (83.2 % vs. 53.8 %, p < 0.001). CONCLUSIONS: The epidemiology, clinical features, and microbiology of purulent and non-purulent cellulitis were significantly different in hospitalized Taiwanese adults. Purulence was a positive predictor of MRSA as the causal agent of cellulitis. These findings provide added support for the adoption of the IDSA guidelines for empirical antimicrobial therapy of cellulitis in Taiwan.
EISSN:
1471-2334
DOI:
10.1186/s12879-015-1064-z
Keywords:
Cellulitis; Methicillin-resistant Staphylococcus aureus; Soft tissue infections; Staphylococcal skin infections
Version:
Final published version
Additional Links:
http://www.biomedcentral.com/1471-2334/15/311

Full metadata record

DC FieldValue Language
dc.contributor.authorLee, Chun-Yuanen
dc.contributor.authorTsai, Hung-Chinen
dc.contributor.authorKunin, Calvin M.en
dc.contributor.authorLee, Susan SJen
dc.contributor.authorChen, Yao-Shenen
dc.date.accessioned2016-05-20T09:03:24Z-
dc.date.available2016-05-20T09:03:24Z-
dc.date.issued2015en
dc.identifier.citationLee et al. BMC Infectious Diseases (2015) 15:311 DOI 10.1186/s12879-015-1064-zen
dc.identifier.doi10.1186/s12879-015-1064-zen
dc.identifier.urihttp://hdl.handle.net/10150/610291-
dc.description.abstractBACKGROUND: The risk factors, microbial etiology, differentiation, and clinical features of purulent and non-purulent cellulitis are not well defined in Taiwan. METHODS: We conducted a retrospective cohort study of hospitalized adults with cellulitis in Taiwan in 2013. The demographic characteristics, underlying diseases, clinical manifestations, laboratory and microbiological findings, treatments, and outcomes were compared for patients with purulent and non-purulent cellulitis. RESULTS: Of the 465 patients, 369 had non-purulent cellulitis and 96 had purulent cellulitis. The non-purulent group was significantly older (p = 0.001) and was more likely to have lower limb involvement (p < 0.001), tinea pedis (p = 0.003), stasis dermatitis (p = 0.025), a higher Charlson comorbidity score (p = 0.03), and recurrence at 6 months post-infection (p = 0.001) than the purulent group. The purulent group was more likely to have a wound (p < 0.001) and a longer hospital stay (p = 0.001) and duration of antimicrobial therapy (p = 0.003) than the non-purulent group. The etiological agent was identified in 35.5 % of the non-purulent cases, with β-hemolytic streptococci the most frequent cause (70.2 %). The etiological agent was identified in 83.3 % of the purulent cases, with Staphylococcus aureus the predominant pathogen (60 %): 50 % of these were methicillin-resistant S. aureus (MRSA). In multivariable analysis, purulent group (odds ratio (OR), 5.188; 95 % confidence interval (CI), 1.995-13.493; p = 0.001) was a positive predictor of MRSA. The prescribed antimicrobial agents were significantly different between the purulent and non-purulent groups, with penicillin the most frequently used antimicrobial agent in the non-purulent group (35.2 %), and oxacillin the most frequent in the purulent group (39.6 %). The appropriate antimicrobial agent was more frequently prescribed in the non-purulent group than in the purulent group (83.2 % vs. 53.8 %, p < 0.001). CONCLUSIONS: The epidemiology, clinical features, and microbiology of purulent and non-purulent cellulitis were significantly different in hospitalized Taiwanese adults. Purulence was a positive predictor of MRSA as the causal agent of cellulitis. These findings provide added support for the adoption of the IDSA guidelines for empirical antimicrobial therapy of cellulitis in Taiwan.en
dc.language.isoenen
dc.publisherBioMed Central Ltden
dc.relation.urlhttp://www.biomedcentral.com/1471-2334/15/311en
dc.rights© 2015 Lee et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0)en
dc.subjectCellulitisen
dc.subjectMethicillin-resistant Staphylococcus aureusen
dc.subjectSoft tissue infectionsen
dc.subjectStaphylococcal skin infectionsen
dc.titleClinical and microbiological characteristics of purulent and non-purulent cellulitis in hospitalized Taiwanese adults in the era of community-associated methicillin-resistant Staphylococcus aureusen
dc.typeArticleen
dc.identifier.eissn1471-2334en
dc.contributor.departmentDivision of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospitalen
dc.contributor.departmentFaculty of Medicine, School of Medicine, National Yang-Ming Universityen
dc.contributor.departmentDepartment of Internal Medicine (CMK), Ohio State University and the University of Arizonaen
dc.contributor.departmentGraduate Institute of Science Education and Environmental Education, Nathional Kaohsiung Normal Universityen
dc.contributor.departmentUniversity of Arizonaen
dc.identifier.journalBMC Infectious Diseasesen
dc.description.collectioninformationThis item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.en
dc.eprint.versionFinal published versionen
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