Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors

October 8, 2016 at 5:51 pm

Clinical Infectious Diseases October 15, 2016 V.63 N.8 P.1034-1041

Trond Bruun, Oddvar Oppegaard, Karl Ove Hufthammer, Nina Langeland, and Steinar Skrede

1Department of Clinical Science, University of Bergen

2Department of Medicine

3Centre for Clinical Research

4National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway

Background. 

Skin and soft tissue infections are common reasons for medical care. Use of broad-spectrum therapy and costs have increased. Assessment of early treatment response has been given a central role both in clinical trials and everyday practice. However, there is a paucity of data on the dynamics of response, causes of early nonresponse, and how early nonresponse affects resource use and predicts outcome.

Methods. 

We prospectively enrolled 216 patients hospitalized with cellulitis. Clinical and biochemical response data during the first 3 days of treatment were analyzed in relation to baseline factors, antibiotic use, surgery, and outcome. Multivariable analysis included logistic lasso regression.

Results. 

Clinical or biochemical response was observed in the majority of patients the day after treatment initiation. Concordance between clinical and biochemical response was strongest at days 2 and 3. Female sex, cardiovascular disease, higher body mass index, shorter duration of symptoms, and cellulitis other than typical erysipelas were predictors of nonresponse at day 3. In contrast, baseline factors were not predictive of clinical failure assessed posttreatment. Among cases with antibiotic treatment escalation by day 2, 90% (37/41) had nonresponse at day 1, but only 5% (2/40) had inappropriate initial therapy. Nonresponse at day 3 was a predictor of treatment duration >14 days, but not of clinical failure.

Conclusions. 

Nonpharmacological factors had a major impact on early response dynamics. Delayed response was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment may often be premature.

PDF

http://cid.oxfordjournals.org/content/63/8/1034.full.pdf+html

Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Infecciones en piel y tej blandos, Metodos diagnosticos, Resistencia bacteriana, Sepsis, Update. Tags: .

Safety Profile of Nifurtimox for Treatment of Chagas Disease in the United States Nosocomial bacteremia due to Kluyvera cryocrescens: Case report and literature review.


Calendar

October 2016
M T W T F S S
« Sep   Nov »
 12
3456789
10111213141516
17181920212223
24252627282930
31  

Most Recent Posts


%d bloggers like this: