Search

Background: Cellulitis is a bacterial skin infection that tends to recur. Previous studies have identified several risk factors that may contribute to its pathogenesis. Obesity is an increasingly prevalent worldwide disease that has been associated with skin and soft tissue infections., Objective: The aim of our systematic review and meta-analysis was to investigate the association of cellulitis with obesity., Methods: The Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for the relevant studies from the inception of each respective database to March 13, 2021. Case-control, cross-sectional, or cohort studies that examined the odds or risk of increased BMI in patients with cellulitis were included. This study was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa scale (NOS) was used to evaluate the risk of bias in included studies., Results: In total, 9 case-control studies were included in our quantitative meta-analysis with a total of 68,148 study participants. A significant association was found between cellulitis and obesity (pooled odds ratio [OR] 2.67, 95% CI 1.91-3.71). No significant association was observed between cellulitis and being overweight (pooled OR 1.69, 95% CI 0.99-2.88). Patients with cellulitis were also found to have 1.63-fold increased odds of being male (pooled OR 1.63, 95% CI 1.12-2.38)., Conclusions: Our findings suggest that cellulitis is significantly associated with obesity. Maintaining a healthy BMI may be indicated for patients presenting with cellulitis., (©Kimi Gabriella Taira, Madelyn Wang, William Guo, Olivia Kam, Tara Kaufmann. Originally published in JMIR Dermatology (http://derma.jmir.org), 20.08.2024.)

Background: Cellulitis is an infection of the skin and the tissues just under the skin. As any disease, cellulitis has various physiological and physical effects that deteriorate a patient's quality of life. Luckily, cellulitis can be treated when dealt with in a timely fashion. Nonetheless, some patients may experience more than one episode of cellulitis or a recurrence of cellulitis that was previously cured. In fact, the occurrences of cellulitis episodes are believed to follow a statistical distribution. The frequency distribution of cellulitis episodes is scrutinized herein. We aimed to investigate the risk factors that affect the number of cellulitis episodes and the pattern of association between cancer types and cellulitis episodes by using analytical and visual approaches. Methods: A statistical approach applying a two-part count regression model was used instead of the traditional one-part count model. Moreover, multiple correspondence analysis was used to support the finding of count regression models. Results: The results of analysis of the sample from the National Cheng Kung University hospital in Taiwan revealed the mean age of patients was 58.7 ± 14.31 years old. The two-part regression model is conceptually and numerically better than the one-part regression model when examining the risks factors that affect cellulitis episodes. Particularly, we found the significant factors based on the best model are cellulitis history ([Formula: see text]; P value < 0.001), clinical stage of cancer (3) ([Formula: see text]; P value < 0.001), no cancer ([Formula: see text]; P value < 0.05), cancer of female reproductive organs ([Formula: see text]; P value < 0.05), breast cancer ([Formula: see text]; P value < 0.05), and age ≥ 60 years ([Formula: see text]; P value < 0.05). Multiple correspondence analysis approach found cancer types (breast and female reproductive organ), age ≥ 60 years, and cellulitis history were more likely to link to excess zero cellulitis or one cellulitis episode., Competing Interests: Disclosures: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Marshfield Clinic Health System.)

Purpose: There are limited studies assessing modifiable preoperative risk factors for pediatric laparoscopic gastrostomy tubes (LGT) and percutaneous endoscopic gastrostomy (PEG) tubes. We sought to evaluate the effect of demographics and surgical/infectious history on the superficial infection rate following gastrostomy tube (GT) placement., Methods: After IRB approval, we conducted a single-institution retrospective cohort study from 2015 to 2021 of pediatric patients undergoing LGT or PEG tube. The primary outcome was cellulitis or abscess formation within 30-days and 90-days postoperatively. Statistical analyses were performed with t-tests, Chi-squared, and logistic regression(p ≤ 0.05)., Results: There were 382 patients, with 181 (47%) LGT and 201 (53%) PEGs. LGT patients were younger (5.9 vs. 12.3 months, p < 0.001) and more likely to be admitted to the neonatal or cardiac intensive care unit prior to their GT. There were similar rates of prior surgical intervention (58% vs. 66%, p = 0.29) and previous infection (37% vs. 38%, p = 0.87) in both LGT and PEG patients. Within 30-days postoperatively, LGT patients had a higher superficial infection rate (12% vs. 6%, p = 0.04). On multivariate regression, Black race (Odds Ratio 0.10, p = 0.03) was protective and prior Staphylococcus colonization (OR 2.35, p = 0.04) increased the odds of infection. In those patients colonized with Staphylococcus, 21% developed a superficial site infection compared to 9% in those not colonized (p = 0.01)., Conclusion: These data suggest prior Staphylococcus colonization is a significant risk factor for superficial infection following GT. Further work into preoperative decolonization strategies may provide an avenue to decrease the high infection rate in this common pediatric procedure., Level of Evidence: Level III., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The aims of this study were: to define the incidence of cellulitis in patients with lymphedema (LED) overall and relate this to the etiology of LED; to determine how this rate might be affected by recurrence of cellulitis; and to quantify the contemporary economic burden of treatment. Understanding these factors is essential in developing targeted cellulitis prevention strategies and reducing health care costs., Methods: The IBM MarketScan Research Database was examined from April 2013 to March 2019 for patients with a new diagnosis of LED (n = 85,601). Based on International Classification of Diseases (ICD)-9/ICD-10 diagnosis codes, the incidence and cost of cellulitis were ascertained during the 3-year follow-up period. Incidence rates (per 100 patient-years [PYs]) and cost (per patient per year) of cellulitis were evaluated among all patients with LED and within subgroups of LED etiologies., Results: Among the three most common morbidities associated with LED (breast cancer-related lymphedema [BCRL], n = 17,954 [20.97%]; gynecological cancer-related LED [GCRL], n = 1256 [1.47%]; and phlebolymphedema [PLED], n = 8406 [9.82%]), rates of cellulitis were markedly lower for BCRL (8.9; 95% confidence interval [CI], 8.7-9.2) and GCRL (14.8; 95% CI, 13.4-16.4) vs PLED (47.7; 95% CI, 46.7-48.8). Patients with a history of cellulitis had markedly higher cellulitis rates during follow-up than those without-overall, 74.0% vs 16.4%; BCRL, 42.9%; 95% CI, 39.7%-46.3% vs 7.6%; 95% CI, 7.3%-7.9%; GCRL, 67.5%; 95% CI, 56.4%-80.8% vs 11.0%; 95% CI, 9.8%-12.4%; and PLED, 81.7%; 95% CI, 79.4%-84.1% vs 30.4%; 95% CI, 29.4%-31.4%, respectively. The mean $/patient/year of cellulitis-related costs for a patient with PLED ($2836; 95% CI, $2395-$3471) was significantly greater than that for BCRL ($503; 95% CI, $212-$1387) and GCRL ($609; 95% CI, $244-$1314)., Conclusions: The incidence of cellulitis associated with LED varies by the etiology of LED. PLED has the highest rates of both an initial cellulitis episode and recurrent cellulitis events. Additionally, PLED has one of the largest cellulitis-related total costs per patient per year. Prevention, as well as early identification and treatment of PLED-associated cellulitis, could significantly decrease health care costs and improve patient quality of life., Competing Interests: Disclosures T.O. was a consultant for Tactile Medical, Minneapolis, MN, when this study was performed. D.W. is the Senior Health Economist at Policy Analysis Inc (PAI), which received funding for this research from Tactile Medical., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: Cellulitis is often treated with antibiotics for longer than recommended by guidelines. Prolonged therapy may reduce recurrence in certain patients, but it is not known which patients are at greatest risk. Our objective was to develop and temporally validate a risk prediction score to identify patients attending hospital with cellulitis at highest risk of recurrence., Methods: We included UK adult patients with cellulitis attending hospital in an electronic health records (EHR) study to identify demographic, comorbid, physiological, and laboratory factors predicting recurrence (before death) within 90 days, using multivariable logistic regression with backwards elimination in complete cases. A points-based risk score integerised model coefficients for selected predictors. Performance was assessed using the C-index in development and temporal validation samples., Results: The final model included 4938 patients treated for median 8 days (IQR 6-11); 8.8% (n = 436) experienced hospitalisation-associated recurrence. A risk score using eight variables (age, heart rate, urea, platelets, albumin, previous cellulitis, venous insufficiency, and liver disease) ranged from 0-15, with C-index = 0.65 (95%CI: 0.63-0.68). Categorising as low (score 0-1), medium (2-5) and high (6-15) risk, recurrence increased fourfold; 3.2% (95%CI: 2.3-4.4%), 9.7% (8.7-10.8%), and 16.6% (13.3-20.4%). Performance was maintained in the validation sample (C-index = 0.63 (95%CI: 0.58-0.67)). Among patients at high risk, four distinct clinical phenotypes were identified using hierarchical clustering 1) young, acutely unwell with liver disease; 2) comorbid with previous cellulitis and venous insufficiency; 3) chronic renal disease with severe renal impairment; and 4) acute severe illness, with substantial inflammatory responses., Conclusions: Risk of cellulitis recurrence varies markedly according to individual patient factors captured in the Baseline Recurrence Risk in Cellulitis (BRRISC) score. Further work is needed to optimise the score, considering baseline and treatment response variables not captured in EHR data, and establish the utility of risk-based approaches to guide optimal antibiotic duration., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an international level. The aim of this study was to identify the frequency of cellulitis in patients with lymphoedema of the arm, including potential risk factors for cellulitis., Methods: An international, multi-centre, cross-sectional study including patients with clinically assessed arm lymphoedema. The primary outcome was the incidence of cellulitis located to the arm with lymphoedema within the last 12 months, and its potential associated risk factors. The secondary outcome was life-time prevalence of cellulitis. Adults with clinically-assessed arm lymphoedema/chronic oedema (all causes) and able to give informed consent were included. End-of-life-patients or those judged as not in the patient's best interest were excluded. Both univariable and multivariable analysis were performed., Results: A total of 2160 patients were included from Australia, Denmark, France, Ireland, Italy, Japan, Turkey and United Kingdom. Secondary lymphoedema was present in 98% of the patients; 95% of these were judged as related to cancer or its treatment. The lifetime prevalence of cellulitis was 22% and 1-year incidence 11%. Following multivariable analysis, factors associated with recent cellulitis were longer swelling duration and having poorly controlled lymphoedema. Compared to having lymphoedema less than 1 year, the risk increased with duration: 1-2 years (OR 2.15), 2-5 years (OR 2.86), 5-10 years (OR 3.15). Patients with well-controlled lymphoedema had a 46% lower risk of cellulitis (OR 0.54, 95% CI 0.39-0.73, p < 0.001). More advanced stages of lymphoedema were associated with cellulitis even after adjustment for swelling duration and control of swelling by logistic regression (stage II OR 5.44, stage III OR 9.13, p = 0.002), demonstrated in a subgroup analysis., Conclusion: Patients with advanced arm lymphoedema are at particular risk of developing cellulitis. Prevention of lymphoedema progression is crucial. The results lend towards a positive effect of having well-treated lymphoedema on the frequency of cellulitis., (© 2024. The Author(s).)

Background: Insect bite inflammation may mimic cellulitis and promote unnecessary antibiotic usage, contributing to antimicrobial resistance in primary care. We wondered how general practice clinicians assess and manage insect bites, diagnose cellulitis, and prescribe antibiotics., Method: This is a Quality Improvement study in which 10 general practices in England and Wales investigated patients attending for the first time with insect bites between April and September 2021 to their practices. Mode of consultation, presentation, management plan, and reattendance or referral were noted. Total practice flucloxacillin prescribing was compared to that for insect bites., Results: A combined list size of 161,346 yielded 355 insect bite consultations. Nearly two-thirds were female, ages 3-89 years old, with July as the peak month and a mean weekly incidence of 8 per 100,000. GPs still undertook most consultations; most were phone consultations, with photo support for over half. Over 40% presented between days 1 and 3 and common symptoms were redness, itchness, pain, and heat. Vital sign recording was not common, and only 22% of patients were already taking an antihistamine despite 45% complaining of itch. Antibiotics were prescribed to nearly three-quarters of the patients, mainly orally and mostly as flucloxacillin. Reattendance occurred for 12% and referral to hospital for 2%. Flucloxacillin for insect bites contributed a mean of 5.1% of total practice flucloxacillin prescriptions, with a peak of 10.7% in July., Conclusions: Antibiotics are likely to be overused in our insect bite practice and patients could make more use of antihistamines for itch before consulting., (© The Author(s) 2023. Published by Oxford University Press.)

Concern for infection is a common presentation in pediatric emergency departments. Clinical signs of cellulitis in pediatric patients often lead to a workup for osteoarticular infection despite a lack of evidence to suggest that the two entities commonly co-exist. With this in mind, we asked: (1) What is the rate of concomitant cellulitis and osteoarticular infections in the pediatric population? (2) What factors are associated with concomitant cellulitis and osteoarticular infections? This is a retrospective study of 482 pediatric patients who underwent MRI to evaluate for either cellulitis or an osteoarticular infection at a single tertiary care children's hospital. Data were analyzed to assess the prevalence of osteomyelitis concomitant with cellulitis in our sample population. Concomitant cellulitis and osteoarticular infection were present in 11% of all cases (53/482). Of the concomitant infections, 92% percent (49/53) were present in distal locations (Group 1) and 8% (4/53) were present in proximal locations (Group 2). Bivariate analysis showed that concomitant infections on the distal extremities were significantly more common than concomitant infections on the proximal extremities ( P  < 0.001). We found that concomitant cellulitis and osteoarticular infection were (1) uncommon and (2) significantly less common when clinical signs of cellulitis were present in the proximal extremities (proximal to ankle or wrist). This suggests that advanced imaging is most appropriate for patients who present with cellulitis on the distal extremities and can be used more judiciously in patients presenting with cellulitis on the proximal extremities. Level of Evidence - Level III., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a human pathogen causing severe invasive infections. Population-based studies on SDSE bacteremia are limited. The purpose of this study was to investigate the incidence, seasonal pattern, clinical manifestations, and recurrence of SDSE bacteraemia. Records regarding patients aged ≥ 18 years with SDSE bacteremia in the Pirkanmaa health district in August 2015 to July 2018 were retrospectively reviewed. A total of 230 SDSE bacteremia episodes were identified, with 217 episodes (involving 211 patients) available for analysis. The mean annual incidence rate of SDSE bacteremia was 16.9/100 000 inhabitants. Most episodes (33%) were detected in the summer (June to August) (p = 0.058). Episodes with bacteremic cellulitis were statistically significantly more common during the summer compared with other seasons (p = 0.008). Cellulitis was the most common presenting clinical manifestation of SDSE bacteremia (68% of all episodes). Risk factors of recurring bacteremia were chronic eczema and/or skin erosion (OR 3.96 [95% CI 1.11-14.1]), heart disease (OR 3.56 [95% CI 1.22-10.4]), diabetes (OR 3.77 [95% CI 1.35-10.5]) and a history of cellulitis. We found a remarkably high incidence of SDSE bacteraemia in the Pirkanmaa health district. Bacteraemic cellulitis, which was the predominant clinical manifestation is more often occurred in the summer. Risk factors of recurring SDSE bacteremia were a history of cellulitis, chronic eczema or skin erosion, diabetes, and heart disease., (© 2023. The Author(s).)

Background: The vast majority of patients with acute tonsillitis (AT) are managed in general practice. However, occasionally patients are referred to hospital for specialized management because of aggravated symptoms and/or findings suggestive of peritonsillar involvement. No prospective studies have been conducted aiming to investigate the prevalent and significant microorganisms in this highly selected group of patients. We aimed to describe the microbiological findings of acute tonsillitis with or without peritonsillar phlegmon (PP) in patients referred for hospital treatment and to point out potential pathogens using the following principles to suggest pathogenic significance: (1) higher prevalence in patients compared to healthy controls, (2) higher abundance in patients compared to controls, and (3) higher prevalence at time of infection compared to time of follow up., Methods: Meticulous and comprehensive cultures were performed on tonsillar swabs from 64 patients with AT with (n = 25) or without (n = 39) PP and 55 healthy controls, who were prospectively enrolled at two Danish Ear-Nose-Throat Departments between June 2016 and December 2019., Results: Streptococcus pyogenes was significantly more prevalent in patients (27%) compared to controls (4%) (p < 0.001). Higher abundance was found in patients compared to controls for Fusobacterium necrophorum (mean 2.4 vs. 1.4, p = 0.017) and S. pyogenes (mean 3.1 vs. 2.0, p = 0.045) in semi-quantitative cultures. S. pyogenes, Streptococcus dysgalactiae, and Prevotella species were significantly more prevalent at time of infection compared to follow up (p = 0.016, p = 0.016, and p = 0.039, respectively). A number of species were detected significantly less frequently in patients compared to controls and the mean number of species was significantly lower in patients compared to controls (6.5 vs. 8.3, p < 0.001)., Conclusions: Disregarding Prevotella spp. because of the prevalence in healthy controls (100%), our findings suggest that S. pyogenes, F. necrophorum, and S. dysgalactiae are significant pathogens in severe AT with or without PP. In addition, infections were associated with reduced diversity (dysbacteriosis)., Trial Registration: The study is registered in the ClinicalTrials.gov protocol database (# 52,683). The study was approved by the Ethical Committee at Aarhus County (# 1-10-72-71-16) and by the Danish Data Protection Agency (# 1-16-02-65-16)., (© 2023. The Author(s).)

The most common cause of the development of odontogenic infection is untreated dental caries, which initially leads to pulpitis. If an odontogenic infection is left untreated, it will pass through the limiting bone plate and will infiltrate deeper structures. Odontogenic infections are different in adults and children. The study was conducted at the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of Upper Silesian Children's Health Center in Katowice in the 2020-2022. We included 27 patients aged 2-16 in the study. Patients were diagnosed with an active, acute odontogenic inflammatory process in the head and neck area. We assessed pain, trismus, extraoral and intraoral swelling and the level of CRP [C Reactive Protein], WBC [White Blood Cells], NLR [Neutrophil Lymphocyte Ratio], D-dimers and Prealbumins. The results were analyzed in terms of the location of the source of inflammation: maxilla or mandible and the type of source of infection: deciduous tooth or permanent tooth. Deciduous teeth are more often the cause of odontogenic infection in the maxilla, while permanent teeth in the mandible. Trismus, extraoral, and intraoral swelling occurred in all infections caused by permanent teeth. The CRP and NLR ratio is statistically higher in infection, which originates from permanent teeth. The mean hospitalization time was also longer for infections from permanent teeth 3.42 days than for deciduous teeth 2.2 days. The varied clinical picture of odontogenic infections in children requires periodic analyzes of statistical data related to epidemiology, etiology, and symptomatology in order to update diagnostic and therapeutic procedures.

Cellulitis is a bacterial infection of the dermis and subcutaneous tissues occupying a large proportion of hospital beds. This study was conducted for analysis of patients with cellulitis according to their demographics and clinical presentation and to examine their comorbidities, complications, and its management. This observational cross-sectional study was conducted in the Department of Surgery at Santosh Medical College and Hospitals involving a total of 60 cases having cellulitis and other soft tissue infections of lower limb. Analysis of their demographic profile, management, and complications was done. Cellulitis is seen commonly in males, 46 (76.6%). The mean age of patients affected by cellulitis in the study was 36.4 ± 1.23 years. The most common site affected is leg involving more people in field jobs. The most common risk factor was trauma in 46.6%, and other factors were diabetes mellitus and smoking, while abscess formation was the most common complication observed in 36.6% of cases. A total of 56.6% cases were managed conservatively, while 43.3% cases required surgical intervention. Mean hospital stay in this study was 5.02 ± 0.23 days. It was concluded that cellulitis is subcutaneous, spreading bacterial infection is more common in males, and its incidence is highest in working age group population. Lower limb is commonly involved. Trauma, smoking, and diabetes are significant risk factors for development of cellulitis. Abscess is the most common complication. About 50% patients with cellulitis can be managed conservatively and the rest require surgical intervention.

Background: Internally penetrating Crohn's Disease complications, including abscesses and phlegmon, represent a high-risk Crohn's Disease phenotype. Anti-tumor-necrosis-factor-α (Anti-TNF) therapies are effective in treating penetrating Crohn's Disease and early initiation has shown unique benefits. However, timing of anti-TNF initiation in the setting of internally penetrating Crohn's Disease complications is typically heterogenous due to concern over precipitating serious infections. Recent studies demonstrate such an association may not exist., Aims: We aimed to describe the multidisciplinary management of pediatric patients with internally penetrating Crohn's Disease complications, focusing on the utilization and timing of anti-TNF therapy relative to complication resolution and adverse events., Methods: We performed a single-center retrospective cohort study of pediatric patients with internally penetrating Crohn's Disease complications from 2007 to 2021. The safety and effectiveness of anti-TNF therapy initiation prior to complication resolution was assessed by comparing rates of infectious and Crohn's Disease-related adverse events between those who received anti-TNF therapy prior to complication resolution, versus those who did not., Results: Twenty-one patients with internally penetrating Crohn's Disease complications were identified. 7/21 received anti-TNF therapy prior to complication resolution. Infectious adverse events within 90 days of complication occurred in 0/7 patients initiating anti-TNF therapy prior to complication resolution and 10/14 patients who did not (p = 0.004). Crohn's Disease-related surgeries and hospitalizations within 1 year of complication occurred in 12/20 patients, with similar frequency between groups., Conclusions: Initiating anti-TNF therapy prior to internally penetrating Crohn's Disease complication resolution may be a safe and effective strategy to improve clinical outcomes., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: The COVID-19 pandemic in France has recently modified the patients' lifestyles, as well as methods of medical and surgical management. This could explain subsequent changes to the microbiological spectrum, the severity, as well as the scalability of phlegmons of the flexor tendon sheath. The objective of this study was to construct an epidemiological and bacteriological inventory of these hand infections, and to compare the clinical and microbiological data, before and after the COVID-19 pandemic., Hypothesis: The hypothesis of this work was that the phlegmons of the flexor tendon sheath presented specific microbiological characteristics in the tropical environment of our University Hospital Center, and that these characteristics could have changed with the recent introduction of hydro-alcoholic solution (HAS) associated to the COVID-19 pandemic., Material and Methods: The preoperative epidemiological data of our patients were collected between January 2016 and December 2020. The stage of severity, according to the classification of Michon, the use of hydro-alcoholic solution, as well as the early clinical evolution were collected. The cohort was then divided into two groups in order to compare the microbiological profiles, the management and the clinical evolution of patients in the pre-COVID period with those in the post-COVID period., Results: A total of 199 patients were included, 154 patients in the pre-COVID period and 26 in the post-COVID period. We found a majority of MSSA (58.3%, N=105) and negative samples comprised 18.9% (N=34). No statistically significant difference was found between the two groups regarding the bacteriological results. The clinical course was judged to be favorable in 93.5% of cases in the pre-COVID group compared to 80.8% in the post-COVID group (p=0.046). The use of HAS (p<0.0001), as well as the initial stage of severity according to Michon, were significantly higher in group 2 (p=0.04)., Discussion: The COVID-19 pandemic has not shown any change in the microbiological spectrum, despite the now daily use of HAS in everyday life. The postoperative clinical evolution was significantly less favorable after the onset of COVID and could be explained by an increase in cases with a more advanced initial stage of severity., Level of Evidence: IV, Observational epidemiological study., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Introduction: Cervicofacial cellulitis is mainly due to neglected oral/pharyngeal diseases. Untreated or incorrectly treated, they can be complicated by thoraco-cervical necrosis, which has a gloomy prognosis and is difficult to manage, especially in an under-medicalized environment. The aim of this work was to report the difficulties of management in precarious context by underlining the interest of primary prevention., Patients and Method: This was a descriptive cross-sectional retrospective study from January 2018 to March., Results: Fifty cases of thoracic-cervical necrosis were collected during this period. The man/woman sex ratio was 3.55. Dental etiology was found in 96% of cases. The main complications were: pneumopathy (n = 10), mediastinitis (n = 10), pleurisy (n = 3) and polyseritis (n = 2). The management combined medical and surgical treatment under local or general anesthesia. The mortality rate was 12.8%. The functional results were satisfactory in surviving cases., Conclusion: The management of thoracic-cervical necrosis remains a challenge in precarious conditions. Primary must play a major role in these conditions., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest in relation to this article., (Copyright © 2022. Published by Elsevier Masson SAS.)

Introduction: Although most localized odontogenic infections can be managed successfully without complications, some can cause extensive morbidity through the onset of cervicofacial cellulitis. The management of these more severe infections generally requires emergency treatment, including surgical treatment under general anesthesia, and prolonged length of hospital stay., Material & Methods: In this work, we assessed the impact of the provision of a hospital-based dental emergency department on the regional incidence of severe odontogenic cellulitis in a socioeconomically precarious region. Monthly case rates of odontogenic cellulitis treated between January 2010 and December 2019 at the hospital-based dental emergency department of Lille Medical University Hospital were collected., Results: The mean number of monthly severe odontogenic cellulitis cases treated under general anesthesia was significantly higher before than after the inception of the hospital-based dental emergency service [14.07 (5.83) vs 8.79 (4.42); p<0.0001]. Conversely, the monthly mean number of collected odontogenic cellulitis cases treated under local anesthesia was significantly lower before the emergency service was set up [22.42 (12.73) vs 43.32 (23.41); p<0.0001]., Conclusion: The provision of a hospital-based dental emergency department resulted in a decrease in severe dental infections in a region with high indices of socioeconomic precarity, morbidity and mortality. Greater accessibility to dental care allows for the rationalization of care through more precocious and fewer burdensome procedures., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Purpose: Cervical cellulitis is an infrequent but serious infection. The management of the upper airways is difficult, at the actual time of intubation but also regarding the necessity of maintaining mechanical ventilation. The objective of this study is to identify risk factors on admission to the intensive care unit for difficult ventilatory weaning in patients with cervical cellulitis., Methods: Between January 2013 and December 2018, this retrospective observational study was performed in an intensive care unit with 10 beds in a university hospital recognized as a reference center for the management of cellulitis. All intensive care patients receiving mechanical ventilation after surgery for cervical cellulitis were eligible. Difficult ventilatory weaning was defined as mechanical ventilation lasting more than 7 days or failure of extubation as established by the WIND 2017 study., Results: We included 120 patients with severe cervical cellulitis. The median age was 43 years. Eighteen patients (16%) presented mediastinal extension. The risk factor for difficult ventilatory weaning (n = 49) in multivariate analysis was a high level of procalcitonin on admission (OR at 1.14[1.005-1.29]; p&lt;0.042) and the protective factor was surgery in an expert center (OR at 0.11[0.026-0.47]; p&lt;0.003). Eight patients required a tracheotomy in our study: 3 patients during surgery and at a later time for the other 5 of our 8 patients., Conclusion: No intensive care studies have investigated ventilatory weaning risk factors in patients with cervical cellulitis. Yet simple criteria seem to predict this risk. It is now necessary to confirm them by a multicenter prospective study., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Objective: The purpose of this study was to assess whether common biological factors are correlated with a longer hospital stay., Study Design: All patients having odontogenic cellulitis, treated from January 2019 to December 2019 at Lille University Hospital, and requiring surgical drainage under general anesthesia, were included, retrospectively. Data, such as length of hospital stay and biological factors, namely, C-reactive protein (CRP) level, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, and bacterial samples were collected., Results: Significant moderate-strong correlations were found between postoperative length of stay and patients' LRINEC score (r s  = 0.556) and presurgical CRP level (r s  = 0.579). There was a significant moderate correlation between postoperative length of stay and presurgical procalcitonin level (r s  = 0.451), and a weak correlation between postoperative length of stay and presurgical white blood cell count (r s  = 0.282). Linear regression verified CRP as an independent predictor of length of hospital stay, showing a significant linear relationship between them (p < 0.0001). A significant regression equation was found (F(1,65) = 27.089; p = 0.0001), with an R 2 of 0.294., Conclusion: In this study, CRP was the key biological predictor of length of hospital stay., Statement of Clinical Relevance: The ability to predict length of hospital stay and identify patients requiring intensive care management, using simple and inexpensive biological parameters (such as CRP), will enable more cost-effective care and efficient hospital bed management., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Trends in emergency department (ED) visits with a primary dermatologic diagnosis are not well characterized., Objective: The goal is to determine how the number of ED visits attributable to dermatologic disease is changing and to characterize the type of dermatologic conditions seen., Methods: This is a cross-sectional study using the National Hospital Ambulatory Medical Care Survey: Emergency Department Summary Tables 2008-2017. Data were compiled into tables on the amount and type of dermatologic ED visits., Results: The percentage of dermatologic visits ranged from an estimated 3.5% to 4.3%, peaking in 2014. Cellulitis was the most common diagnosis and accounted for an estimated 1.3% of all visits in 2016, and an estimated 1.2% of visits in 2017. The second most common diagnosis was cutaneous abscess, which accounted for an estimated 0.8% in 2016 and 0.9% in 2017., Conclusion: The number of ED visits attributed to disease of the skin and subcutaneous tissue has not followed a general trend of increase or decrease. The most common diagnoses are infections. We can best serve these patients by emphasizing the importance of ED provider education on the management of cutaneous infections and by working to increase the accessibility of dermatologic care.

Periorbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the prognosis for vision and survival., Purpose: The goal of this study was to analyze the epidemiological and therapeutic features and outcomes of periorbital cellulitis cases treated in the pediatric emergency department., Patients and Methods: A retrospective study including all the children aged between 1 month and 15 years treated for periorbital cellulitis in the Pediatric Emergency Department of the Mohamed VI University Teaching Hospital in Marrakech over a period of 10 years (January 1, 2010-December 31, 2019)., Results: In all, 168 cases of periorbital cellulitis were recorded, with an increasing of the number of cases, from 2 in 2010 to 39 in 2019. The most affected age bracket was the group under 5 years of age (62.5%). The most frequent mode of entry was sinusitis (22%). Preseptal cellulitis was most common (76.7%). The main clinical signs found in orbital cellulitis were proptosis (64%) and chemosis (35.8%), versus conjunctival hyperemia (78%) in preseptal cellulitis. Ophthalmoplegia was present in two cases of orbital cellulitis. The right side was most affected (44%). An orbital CT scan was performed in all cases in our study, showing preseptal cellulitis in 129 patients (76.7%), orbital cellulitis in 14 cases (8.3%), subperiosteal abscess in 20 cases (12%) and orbital abscess in 5 cases (3%). Prior treatment with non-steroidal anti-inflammatory medication was noted in 6%. The most commonly used antibiotic was amoxicillin-clavulanic acid. Steroid treatment was prescribed in 6% of cases. Surgical treatment was indicated in 12 patients (7.1%). The mean hospital length of stay was 3 days for the preseptal cases and 8 days for the orbital cases. All patients had good outcomes with medical and/or surgical treatment. With follow-up of over one year, no complications were noted., Conclusion: The majority of our cases had positive outcomes, highlighting the advantage of early diagnosis, adapted antibiotic treatment and multidisciplinary care, rendering surgery rarely necessary., (Copyright © 2021. Published by Elsevier Masson SAS.)

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Cellulitis is one of the most important troubling complications of breast cancer treatment. Therefore, elucidating the risk factors for cellulitis in patients that have undergone breast cancer treatment is crucial. This is a retrospective medical record study among 523 patients who had received breast cancer treatment and were referred to the Lymphedema Clinic. Data on age, height, weight, BMI (body mass index), education level, arm dominance, history of previous surgery, axillary lymph node dissection, radiotherapy, and chemotherapy were noted. The time between operation and onset of lymphedema, duration of lymphedema, history of cellulitis, and number of cellulitis attacks were recorded. Circumference measurements were taken at four points on the upper limb. Univariate analysis showed that longer duration of lymphedema, larger circumference of the unaffected arm and larger circumference of the arm with lymphedema were associated with higher risk of cellulitis (p=0.008, p=0.007, p< 0.001, respectively). The incidence of cellulitis was higher in patients with lymphedema than patients who had no lymphedema (p< 0.001). Moreover, the frequency of cellulitis was higher in patients with lower education level (p=0.015). It was deter-mined that patients with cellulitis needed more compression garments (p< 0.001) and multi-layered bandage therapy (p< 0.001) than those without. Regression analysis revealed that presence of lymphedema (p=0.036), duration of lymphedema (p=0.048), radiotherapy (p=0.01) and educational level (0.019) are significantly associated with developing upper extremity cellulitis. It is important to consider these risk factors for the prevention and management of cellulitis in patients who undergo treatment for breast cancer. Early detection and treatment of lymphedema also remains essential for these patients., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright by International Society of Lymphology.)

Background: Although inflammation and thrombosis are tightly connected, only 45% of patients with lower leg cellulitis receive anticoagulant therapy. Available data about the prevalence of concomitant deep venous thrombosis (DVT) in patients with cellulitis of the lower extremity is scarce and general guidelines regarding diagnosis and prevention of venous thromboembolism are missing., Objective: We sought to determine how frequently DVT occurs as an incidental finding in patients with cellulitis and to provide recommendations for diagnostics and anticoagulant therapy., Methods: Patients' records were analysed and 192 consecutive patients with cellulitis were included in this study. The prevalence of concomitant DVT was examined by duplex ultrasound, as well as comorbidities and risk factors., Results: We detected thrombosis in 12.0% of the patients with lower leg cellulitis, of which 43.5% were located in a proximal vein and 52.2% in the veins of the calf., Conclusions: Our results clearly indicate that cellulitis is not only a differential diagnosis, but should be considered a risk factor for venous thrombosis. Therefore, prophylactic anticoagulation should be considered in patients suffering from cellulitis and a systematic screening for venous thrombosis in patients with cellulitis should be performed.

Background: Limb lymphedema is a chronic disease with primary and secondary forms, with the latter occurring essentially after cancer treatment. In the present study, we retrospectively analyzed the cellulitis frequency and its associated risk factors for patients with primary or secondary limb lymphedema., Methods: Information from all 1991 patients referred to a specialized lymphedema center from January to June 2018 was collected, including previous cellulitis episodes and the clinical and lymphedema characteristics., Results: Of the 1846 patients whose information could be analyzed, 695 (37.6%) had experienced one or more cellulitis episodes, and 23.3% had had recurrent cellulitis. Cellulitis occurred in 39.5%, 30.5%, and 38.6% (P = .02) of the patients with secondary upper limb, secondary lower limb, and primary lower limb lymphedema, respectively. The corresponding duration of lymphedema was 106.5, 97, and 243.1 months. For secondary upper limb lymphedema, a long interval from lymphedema onset to the first consultation at our specialized center, younger age at lymphedema onset, and the use of radiotherapy were independently associated with cellulitis. However, axillary lymph node excision, the use of chemotherapy, and segmentation of the upper limb lymphedema were not associated with cellulitis. A longer interval from lymphedema onset to the first consultation and lymph node excision were associated with cellulitis in those with lower limb secondary lymphedema but higher body mass index and younger age at lymphedema onset were not. For primary lower limb lymphedema, male sex, greater body mass index, and younger age at lymphedema onset were associated with cellulitis., Conclusions: Different risk factors for cellulitis were identified for patients with lymphedema at risk. Awareness of those factors is important for physicians to recognize lymphedema promptly and refer patients to specialized centers to optimize treatment., (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The UK has one of the highest rates of recreational drug use and consequent deaths in Europe. Scotland is the "Drug deaths capital of Europe." Intravenous drug use can result in limb- and life-threatening pathology. This study aimed to characterise limb-related admissions associated with intravenous drug use, outcomes and healthcare expenditure., Methods: Retrospective data collection between December 2011 and August 2018. Patients were identified through discharge codes. Admission details were extracted from electronic records and a database compiled. Statistical analyses were performed using Statistical Package for the Social Science, P < 0.05 denoted significance., Results: There were 558 admissions for 330 patients (1-9 admissions/patient), mean age 37 years (+/-7.6 SD) and 196 (59.2%; 319 admissions, 57.2%) were male. Three hundred forty-eight (62.4%) admissions were to surgical specialties, predominantly Vascular Surgery (247). Including onward referrals, Vascular ultimately managed 54.8% of admissions. Patients presented with multiple pathologies: 249 groin abscesses; 38 other abscesses; 74 pseudoaneurysms; 102 necrotising soft tissue infections (NSTI); 85 cellulitis; 138 deep venous thrombosis (DVTs); 28 infected DVTs and 70 other diagnoses. Two hundred and seventy-seven admissions (220 patients) required operations, with 361 procedures performed (1-7 operations/admission). There were 24 major limb amputations and 74 arterial ligations. Eleven amputations were due to NSTI and 13 followed ligation (17.6% of ligations). During follow-up 50 (15.2%) patients died, of which 6 (12%) had amputations (OR 3.2, 95% CI 1.04-9.61, P = 0.043). Cumulative cost of acute care was £4,783,241., Conclusions: Limb-related sequalae of intravenous drug use represents a substantial surgical workload, especially for Vascular. These are complex, high-risk patients with poor outcomes and high healthcare costs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The association between textured surface breast implants and breast implant-associated anaplastic large cell lymphoma has led to an increase in surgical procedures to exchange textured devices to smooth surface implants. Because patient satisfaction is an integral part of breast reconstruction, the purpose of this study was to compare patient-reported outcomes between smooth and textured implant recipients., Methods: Patients aged 18 years or older who underwent implant-based postmastectomy breast reconstruction with either smooth or textured devices from 2009 to 2017 and completed the BREAST-Q patient-reported outcome measure following reconstruction were included in this analysis. The primary outcomes of interest were mean and median BREAST-Q scores and postoperative complications., Results: Overall, 1077 patients were included-785 who underwent breast reconstruction with smooth implants and 292 who underwent breast reconstruction with textured implants. No statistical differences were observed between the textured and smooth implant groups for any of the BREAST-Q domain scores at any of the early (3-month) to late (2-year) postoperative time points. Smooth implant recipients reported significantly more rippling (p = 0.003) than textured implant recipients. In contrast, textured implant recipients had a higher rate of cellulitis than smooth implant recipients (p = 0.016)., Conclusions: These data suggest that postoperative satisfaction with breasts or health-related quality of life following immediate postmastectomy implant-based breast reconstruction is likely independent of implant surface type. However, smooth breast implants may result in more rippling. The authors' findings represent an important aid in counseling patients who have questions about the risks and benefits of replacing their textured implants with smooth surface devices., Clinical Question/level of Evidence: Therapeutic, III., Competing Interests: Disclosure:Dr. Pusic is a codeveloper of the BREAST-Q, which is owned by Memorial Sloan Kettering Cancer Center, and receives a portion of the licensing fees (royalty payments) when the BREAST-Q is used in industry-sponsored clinical trials. Dr. Dayan is a consultant for Stryker. Dr. Mehrara is a consultant for PureTech Corporation. The remaining authors declare no conflicts of interest., (Copyright © 2021 by the American Society of Plastic Surgeons.)

Objectives: Anecdotal evidence suggests that oropharyngeal squamous cell carcinoma (OPSCC) should be suspected in patients presenting with symptoms of peritonsillar abscess (PTA) or cellulitis (PTC). The aim of this study was to estimate the prevalence of OPSCC in patients presenting with symptoms of PTA/PTC., Method, Setting and Participants: We retrospectively identified all adults with a coded diagnosis of PTA or PTC who presented between 2012 and 2016 inclusive, across six ENT units in Merseyside. Records were compared to that of the centralised regional head and neck cancer database. The clinical records of a subset of patients were reviewed for the purposes of data validation., Results: A total of 1975 patients with PTA/PTC were identified. Three patients were subsequently diagnosed with OPSCC. None of the three actually had an objective underlying diagnosis of PTA/PTC on the same side. The prevalence of OPSCC in patients admitted with symptoms of PTA/PTC was 0.15% or approximately 1:650 admissions. The records of 510 patients who presented over a one-year period (2016) were reviewed in even greater detail. There were 298 patients with PTA (59.4%) and 151 with PTC (29.1%) and 61 had an alternative diagnosis (11.9%). High-risk features (age ≥40, tonsillar asymmetry or tonsillar lesion) were present in 106 patients (24%). Urgent follow-up was expedited for 77 patients (73%)., Conclusion: This study estimates the risk of OPSCC in patients with peritonsillar symptoms. The prevalence is low, even in a region with a relatively heavy disease burden. Clinicians should, however, retain a high level of suspicion in patients with persistent symptoms., (© 2021 John Wiley & Sons Ltd.)

Background: Cellulitis is frequently encountered in patients with lymphedema despite existing prevention protocols. To resolve this issue, social aspects surrounding patients, such as communication with patients and professionals, are necessary to consider new approaches. This study aimed to clarify the association between the history of cellulitis in patients with lymphedema and access to specialists after adjustment for relevant confounding factors. Methods and Results: This study was a secondary analysis of the Lymphoedema IMpact and PRevalence-INTernational (LIMPRINT) study using a national Japanese database of adult lymphedema compiled between 2014 and 2015 ( n  = 113). Descriptive data were collected for patient characteristics. Multivariate logistic regression analysis was conducted to explore possible risk factors for patients having experienced cellulitis. The duration of edema ranged from <6 months (16.2%) to 10 years or longer (25.2%), with varying severity. History of cellulitis was observed in 31.9% of patients. The prevalent treatment techniques within the context of complex decongestive therapy included skin care advice (52.2%), compression garments (55.8%), exercise advice (41.6%), multilayer bandages (38.1%), cellulitis advice (49.6%), and massage (61.1%). Overall, 57.1% of patients had access to lymphedema specialists. Longer duration of lymphedema (adjusted odds ratio [AOR] = 4.10, p  = 0.005) and access to lymphedema specialists (AOR = 0.28, p  = 0.009) were significantly associated with a history of cellulitis. Conclusions: A history of cellulitis in patients with lymphedema is associated with limited access to specialists. To support self-care in this patient population, reasonable consideration systems, including telehealth, should be developed to facilitate communication between specialists and patients and decrease the occurrence of cellulitis in lymphedema.

The features of abscess that forms in cellulitis patients were investigated. Among 449 cellulitis cases, about 15% developed abscess, and about 70% of teenaged patients were abscess cases. Furthermore, abscess in the younger age group occurred almost exclusively among male patients. The lesion was predominantly concentric at all ages in the abscess group and in teenagers in the non-abscess group. In contrast, it was diffuse in patients ≥20 years old in the non-abscess group. The clinical symptoms and laboratory values in the abscess group were generally more severe than those in the non-abscess group, especially in the older age group. The abscess sizes increased with the initial area of the lesions. Most abscess cases received incision, and post-incision ulcers were mostly conservatively treated. The duration required for treatment termination was >30 days longer in the abscess group than in the non-abscess group. When post-incision ulcers were conservatively treated, the duration until healing increased with abscess size. However, the durations did not significantly differ between the conservatively and surgically treated groups. When surgically treated, many ulcers healed within 19 days after operation and the outpatient follow-up period tended to be relatively short. Most teenaged patients were student athletes, and thus needed an early return to competition. The main cause in these patients was bruising during sports, with rugby football the most common causative sport. Ulcer closure by operation was suggested to be preferable for shortening the outpatient follow-up period, especially for student athlete patients., (© 2021 Japanese Dermatological Association.)

Objective: To describe common bacterial organisms cultured from retrobulbar cellulitis and abscess lesions, in vitro susceptibility patterns, common diagnostic techniques utilized, etiologies encountered, and prevalence of blindness., Animals Studied: Thirty-eight dogs diagnosed with retrobulbar cellulitis or abscessation from 2007 to 2017., Procedure: For cases of orbital cellulitis or abscess, signalment, orbital imaging, cytology, histopathology, bacterial culture and susceptibility testing, presence of vision at the initial examination and resolution, and presumed cellulitis/abscess etiology were recorded., Results: Most cases were medically (78.9%) versus surgically managed (18.4%). Most common form of orbital imaging was computed tomography (48.5%) followed by ocular ultrasound (18.2%). Fifteen of eighteen cultures (83.3%) showed growth of aerobic bacterial organisms, anaerobic bacterial organisms, or both. Most common aerobic bacteria were gram-negative bacilli (40.0%) followed by Corynebacterium sp. (26.7%) and α-hemolytic Streptococci sp. (26.7%) but Micrococcus and Bacillus spp. were also identified. Most common anaerobic bacteria were gram-negative bacilli (40.0%). Antibiotics with highest susceptibility patterns included gentamicin, followed equally by amoxicillin/clavulanic acid, cephalothin, chloramphenicol, and imipenem. No bacteria were susceptible to cefovecin. Six cases presented with vision loss due to retrobulbar disease (15.8%). Idiopathic (50%) disease and tooth root abscessation (23.7%) were most commonly diagnosed cause of orbital disease., Conclusion: Retrobulbar cellulitis/abscess is a serious and vision-threatening process, which can be effectively managed by broad-spectrum antibiotics such as gentamicin or amoxicillin/clavulanic acid, but not cefovecin. This study identified three organisms that have not been previously reported to be associated with orbital cellulitis (Corynebacterium sp., Bacillus sp. and Micrococcus sp.)., (© 2021 American College of Veterinary Ophthalmologists.)

Background: Cellulitis and chronic oedema are common conditions with considerable morbidity. The number of studies designed to assess the epidemiology of cellulitis in chronic oedema is scarce., Objectives: To investigate the prevalence and risk factors of cellulitis in chronic leg oedema, including lymphoedema., Methods: A cross-sectional study included 40 sites in nine countries during 2014-17. Adults with clinically proven unilateral or bilateral chronic oedema (oedema > 3 months) of the lower leg were included. The main outcome measures were frequency and risk factors for cellulitis within the last 12 months., Results: Out of 7477 patients, 15·78% had cellulitis within the last 12 months, with a lifetime prevalence of 37·47%. The following risk factors for cellulitis were identified by multivariable analysis: wounds [odds ratio (OR) 2·37, 95% confidence interval (CI) 2·03-2·78], morbid obesity (OR 1·51, 95% CI 1·27-1·80), obesity (OR 1·21, 95% CI 1·03-1·41), midline swelling (OR 1·32, 95% CI 1·04-1·66), male sex (OR 1·32, 95% CI 1·15-1·52) and diabetes (OR 1·27, 95% CI 1·08-1·49). Controlled swelling was associated with a reduced risk (OR 0·59, 95% CI 0·51-0·67). In a subgroup analysis, the risk increased with the stage of oedema [International Society of Lymphology, stage II OR 2·04 (95% CI 1·23-3·38) and stage III OR 4·88 (95% CI 2·77-8·56)]., Conclusions: Cellulitis in chronic leg oedema is a global problem. Several risk factors for cellulitis were identified, of which some are potentially preventable. Our findings suggest that oedema control is one of these. We also identified that advanced stages of oedema, with hard/fibrotic tissue, might be an important clinical indicator to identify patients at particular risk., (© 2021 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Background: Little is known about the use and burden of emergency department (ED) visits for cellulitis/erysipelas in the United States., Objective: To determine the prevalence, risk factors, complications, and cost of emergency care for cellulitis/erysipelas in the United States., Methods: Cross-sectional study of the 2006 to 2016 National Emergency Department Sample, including a 20% sample of US ED visits (N = 320,080,467)., Results: The mean annual incidence of ED visits with a primary diagnosis of cellulitis/erysipelas was 2.42 to 3.55 per million adult and 1.14 to 2.09 per million pediatric ED visits. ED visits for cellulitis/erysipelas decreased significantly from 2006 to 2015 (Rao-Scott chi-square, P < .0001). ED visits with versus without a primary diagnosis of cellulitis/erysipelas were associated with public or no insurance and lower household income quartiles, and were more likely to occur during weekends and summer months. The mean cost of ED visits for cellulitis/erysipelas more than doubled in adults (from $720 to $1680) and tripled in children (from $939 to $2,823) from 2006 to 2016. ED visits for cellulitis/erysipelas were associated with multiple risk factors and increased infectious complications., Limitations: No data on cellulitis and erysipelas treatment or recurrence., Conclusion: There is a substantial and increasing burden of ED visits for cellulitis/erysipelas in the United States. Many ED visits occurred for uncomplicated cellulitis/erysipelas, in part because of health care disparities., Competing Interests: Conflicts of interest None reported., (Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

This study aims to identify factors associated with duration of intravenous (IV) and follow-on oral antibiotic therapy for cellulitis in patients treated through outpatient parenteral antimicrobial therapy (OPAT). A retrospective review of episodes of cellulitis treated over a year (January 2018-January 2019) at a large teaching hospital in Sheffield, UK. Overall, 292 OPAT episodes of cellulitis were reviewed. The mean durations of IV therapy and follow-on oral antibiotics were 5.3 days (range 1-32 days) and 6.1 days (range 2-17 days), respectively. Age, peak C-reactive protein and frequency of medical assessments during OPAT were independently associated with longer duration of IV therapy. Senior clinicians were likely to prescribe shorter courses of follow-on oral antibiotics. IV to oral conversion was more likely to occur on the first day of the work week. Our findings suggest that clinical and OPAT-related factors can influence early conversion to oral antibiotic therapy., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Cellulitis is an infection of the soft tissues of the skin. Some patients are hospitalized multiple times; lymphedema, chronic venous insufficiency, peripheral circulatory disturbance, and deep vein thrombosis are said to be risk factors for multiple admissions. Conversely, in Japan, elderly women and undernourished elderly have been reported to be at risk of multiple hospitalizations, suggesting a different patient background from that reported overseas. We investigated the characteristics of readmission cases for patients hospitalized for cellulitis in Japan. We retrospectively examined cases of cellulitis and erysipelas admitted between April 1, 2005 and March 31, 2018. Patients with cellulitis or erysipelas at multiple sites and those with osteomyelitis, pressure ulcer infection, and necrotizing fasciitis were excluded. In terms of recurrence, only hospitalizations for recurrence at the same site were considered. Patients with multiple hospitalizations had significantly lower blood albumin levels than those hospitalized only once. Furthermore, the rates of lymphedema, hypertension, and hyperlipidemia were significantly higher in patients hospitalized multiple times. Other laboratory and clinical factors were not statistically significant. Therefore, hypoalbuminemia with or without liver dysfunction, lymphedema, hypertension, and hyperlipidemia were suggested as risk factors for cellulitis recurrence. However, chronic venous insufficiency, peripheral circulatory disturbance, and deep vein thrombosis did not seem to be risk factors in Japanese cases. Japanese cases had a low body mass index (approximately 25 kg/m 2 ), suggesting that the patient background may be different from that in existing reports. This suggests that the risk factors in Japanese cases may be different from those reported in other countries., (© 2021 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

During 1 January 2016-30 September 2020, there were 210,914 incident cases of skin and soft tissue infections (SSTIs) among active component U.S. military members, corresponding to a crude overall incidence rate of 352.8 per 10,000 person-years (p-yrs). An additional 4,250 cases occurred in theaters of operations (251.0 per 10,000 p-yrs). Of the total incident SSTI diagnoses, 64.5% were classified as cellulitis/abscess, 30.0% were "other SSTIs" (e.g., folliculitis, impetigo), 5.3% were carbuncles/furuncles, and 0.2% were erysipelas. Crude annual incidence rates declined by 21.9% over the surveillance period. In general, higher rates of SSTIs were associated with younger age, recruit/trainee status, and junior enlisted rank. A total of 174,893 service members were treated for SSTIs, which accounted for 307,160 medical encounters and 14,819 hospital bed days. SSTIs in the military are associated with significant operational and health care burden. Strategies for the prevention, early diagnosis, and definitive treatment of SSTIs are warranted, particularly in initial military training and operational settings associated with increased risk of infection.

Objective: To report the 2-year efficacy and safety of tocilizumab (TCZ) in patients with polyarticular-course juvenile idiopathic arthritis (JIA)., Methods: Patients ages 2-17 years with active polyarticular-course JIA, in whom treatment with methotrexate was unsuccessful, received 16 weeks of open-label intravenous TCZ in part 1 (once every 4 weeks: 8 mg/kg or 10 mg/kg for body weight [BW] <30 kg; 8 mg/kg for BW ≥30 kg). Assessments were based on the JIA-American College of Rheumatology (ACR) response (defined as percentage of improvement in ≥3 of the 6 JIA core response variables [CRVs]). Patients with at least a JIA-ACR30 response (defined as ≥30% improvement in ≥3 of the 6 JIA CRVs without worsening in >1 of the remaining JIA CRVs by >30%) at week 16 were randomly assigned (1:1) to receive TCZ or placebo in part 2. Patients remained in part 2 until either week 40 or the occurrence of JIA flare. Upon starting part 3, all patients received open-label TCZ. At week 104 of the study, efficacy was assessed using JIA-ACR50/70/90 response rates (defined as 50%, 70%, or 90% improvement, respectively), achievement of inactive disease, and the Juvenile Arthritis Disease Activity Score in 71 joints (JADAS-71). Safety was assessed in the all-exposure population per 100 patient-years of exposure., Results: Overall, 188 patients entered part 1, 166 patients entered part 2, and 160 patients entered part 3. By week 104, among the 188 patients in the modified intent-to-treat group who received TCZ, JIA-ACR50/70/90 response rates were 80.3%/77.1%/59.6%, respectively, the median JADAS-71 score decreased from 3.6 at week 40 to 0.7 at week 104, 51.1% of patients had achieved inactive disease, and 31 of 66 patients who had been receiving glucocorticoids discontinued them. Adverse event (AE) and serious AE rates were 406.5 per 100 patient-years and 11.1 per 100 patient-years, respectively. The infection rate was 151.4 per 100 patient-years, and the serious infection rate was 5.2 per 100 patient-years., Conclusion: Patients treated with TCZ for polyarticular-course JIA showed high-level disease control for up to 2 years. The TCZ safety profile was consistent with that previously reported., (© 2020 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Cellulitis is a common infection of the skin and subcutaneous tissue caused predominantly by gram-positive organisms. Risk factors include prior episodes of cellulitis, cutaneous lesions, tinea pedis, and chronic edema. Cellulitis is a clinical diagnosis and presents with localized skin erythema, edema, warmth, and tenderness. Uncomplicated cellulitis can be managed in the outpatient setting with oral antibiotics. Imaging often is not required but can be helpful. Recurrent cellulitis is common and predisposing conditions should be assessed for and treated at the time of initial diagnosis. For patients with frequent recurrences despite management of underlying conditions, antimicrobial prophylaxis can be effective., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Persons who inject drugs are at high risk for skin and soft tissue infections. Infections range from simple abscesses and uncomplicated cellulitis to life-threatening and limb-threatening infections. These infections are predominantly caused by gram-positive organisms with Staphylococcus aureus, Streptococcus pyogenes, and other streptococcal species being most common. Although antimicrobial therapy has an important role in treatment of these infections, surgical incision, drainage, and debridement of devitalized tissue are primary. Strategies that decrease the frequency of injection drug use, needle sharing, use of contaminated equipment, and other risk behaviors may be effective in preventing these infections in persons who inject drugs., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Erysipelas is defined by a sudden onset (with fever) preceding the appearance of a painful, infiltrated, erythematous plaque, accompanied by regional lymphadenopathy. It is usually localized on the lower limbs, but it can occur on the face. It is due to β-hemolytic streptococcus A and more rarely to staphylococcus aureus. It is important to establish the diagnosis and eliminate the non-bacterial causes of inflammatory edema. The other diagnoses frequently found are contact eczema, acute arthritis, bursitis, inflammatory flare-up of chronic dermohypodermitis of venous origin, flare-up of chronic multifactorial eczema (venous insufficiency, vitamin deficiencies, senile xerosis and/or contact eczema), rare familial periodic fevers, rare neutrophilic dermatoses or eosinophilic cellulitis. It is necessary to identify signs of severity that would justify hospitalization. In front of a typical acute bacterial dermohypodermitis and in the absence of comorbidity, no additional investigation is necessary. Systematic blood cultures have low profitability. Locoregional causes must be identified in order to limit the risk of recurrence which remains the most frequent complication. In uncomplicated erysipelas, amoxicillin is the gold standard; treatment with oral antibiotic therapy is possible if there is no sign of severity or co-morbidity (diabetes, arteritis, cirrhosis, immune deficiency) or an unfavorable social context. In case of allergy to penicillin, pristinamycin or clindamycin should be prescribed. Prophylactic antibiotic therapy with delayed penicillin is recommended in the event of recurrent erysipelas., (Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Objective: We know that diabetes predisposes to common infections, such as cellulitis and pneumonia. However, the correlation between the level of glycemic control and the rate of infection is unknown., Research Design and Methods: We examined the association between glycemic control in patients with diabetes and the incidence of infection in the entire population of patients with diabetes in a large HMO. During the study period, we first selected an HbA 1c test for each patient and then searched for an infection diagnosis in the 60 days that followed the test. A multivariate logistic regression analysis was performed to determine the independent effect of HbA 1c on the likelihood of being diagnosed with an infection. We were able to control for many confounders, such as other chronic illness, time since the diagnosis of diabetes, and use of steroids before the infection., Results: We identified 407 cases of cellulitis. Multivariate logistic regressions for cellulitis showed a 1.4-fold increased risk among patients with HbA 1c >7.5% (58 mmol/mol). Factors such as obesity, Parkinson's disease, peripheral vascular disease, and prior treatment with prednisone predisposed to cellulitis. There was an increase of 12% in the odds of cellulitis for every 1% (11 mmol/mol) elevation in HbA 1c (odds ratio [OR] 1.12; CI 1.05-1.19). A similar analysis showed a trend toward an increased risk of pneumonia in patients with HbA 1c >7.5% (58 mmol/mol) (OR 1.1; CI 0.9-1.4)., Conclusions: Poor glycemic control was associated in this study with the development of cellulitis. The study also suggests that exposure to oral prednisolone increases the risk of cellulitis, pneumonia, and upper respiratory infection., (© 2020 by the American Diabetes Association.)

Objectives: In preparation for the future arrival of a group A Streptococcus (GAS) vaccine, this study estimated the economic and health burdens of GAS diseases in New Zealand (NZ)., Methods: The annual incidence of GAS diseases was based on extrapolation of the average number of primary healthcare episodes managed each year in general practices (2014-2016) and on the average number of hospitalizations occurring each year (2005-2014). Disease incidence was multiplied by the average cost of diagnosing and managing an episode of disease at each level of care to estimate the annual economic burden., Results: GAS affected 1.5% of the population each year, resulting in an economic burden of 29.2 million NZ dollars (2015 prices) and inflicting a health burden of 2373 disability-adjusted life years (DALYs). Children <5 years of age were the most likely age group to present for GAS-related healthcare. Presentations for superficial throat and skin infections (predominantly pharyngitis and impetigo) were more common than other GAS diseases. Cellulitis contributed the most to the total economic and health burdens. Invasive and immune-mediated diseases disproportionately contributed to the total economic and health burdens relative to their frequency of occurrence., Conclusion: Preventing GAS diseases would have substantial economic and health benefits in NZ and globally., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Lymphedema is a debilitating chronic condition with no definitive curative treatment. There is a paucity of data on prevalence, mortality and burden of care in the United States. This study aimed to describe hospitalizations due to lymphedema and identify factors associated with poor outcomes., Study Design: We performed a retrospective analysis of the Healthcare Cost and Utilization Project National Inpatient Sample for lymphedema-related hospitalizations from 2012 to 2017. All adults admitted with a primary diagnosis of lymphedema or a primary diagnosis of extremity cellulitis and secondary diagnosis of lymphedema were included. Weights were used to obtain national estimates and complex sampling structure was accounted for using survey methods. Chi-squared tests were performed to assess the association between patient demographics, hospital characteristics, and inpatient mortality., Results: Between 2012 and 2017, there were an estimated 165,055 lymphedema admissions in the United States. The vast majority of hospitalizations were for cellulitis (92%), lower extremity disease (88%), and were admitted through the emergency room (77%). Median length of stay was 3.61 days (IQR 2.24-5.77) and inpatient mortality was 0.03% (n = 505). Age >80yrs (OR 3.83, 95% CI 1.72, 8.52) and Charlson comorbidity index ≥3 (OR 4.13, 95% CI 2.19, 7.79) were associated with increased risk of inpatient mortality., Conclusion: Although mortality is low, lymphedema-related hospitalizations are a significant burden to the US healthcare system. Counseling older lymphedema patients with comorbidities on early symptoms and signs of infection and prompt treatment of same may reduce mortality., (Copyright © 2020 Elsevier Ltd. All rights reserved.)