<p>Out Of Hospital And In Hospital Management Of Cellulitis Requiring Intravenous Therapy</p>

Abstract

BackgroundCellulitis requiring intravenous therapy can be managed via out of hospital programs, but a high number of patients are still admitted to hospital.ObjectiveWe aimed to review the clinical features, management and outcomes of patients with cellulitis requiring intravenous therapy in a Hospital in the Home (HITH) program compared to patients who are admitted to hospital.MethodsA prospective cohort study of patients with limb cellulitis requiring intravenous antibiotics was conducted at a metropolitan principal referral hospital.ResultsA total of 100 patients out of 113 eligible patients were recruited. Forty-eight were treated entirely in hospital and 52 were treated entirely or partially via HITH. Patients treated in hospital were older (mean 69.2 vs 56.7 years, p<0.001), less mobile, have more comorbidities (Charlson Comorbidity Index mean 2.2 vs 1.2, P=0.005) and more associated active illness. All patients with Eron Class III were admitted to hospital. Patients treated in hospital had a higher incidence of acute renal failure (27.1% vs 3.8%, p=0.001), nosocomial infection (10.4% vs 0.0%, P=0.023), and a higher 28-day hospital readmission rate (10.4% vs 0.0%, P=0.023).ConclusionApproximately half of the patients who require intravenous therapy can be treated via an out of hospital program. Patients admitted to hospital were more unwell and more likely to suffer complications. The presence of comorbid illness does not necessarily exclude participation in HITH and careful selection is essential to ensure safe outcomes.

Non-purulent skin and soft tissue infections: predictive power of a severity score and the appropriateness of treatment in a prospective cohort

“…Similar practice has also been reported outside the Scandinavian countries [27]. To consider such therapy as over-treatment is debateable in our setting, although increasing knowledge supports use of oral antimicrobial therapy or outpatient intravenous therapy in such cases [28,29]. A disadvantage of early outpatient therapy is that it frequently involves more broad-spectrum drugs.…”

Observational study of the incidence and factors associated with patient readmission from home‐based care under the Hospital in the Home programme

“…Patients admitted to hospital could be more unwell and likely to suffer from complications but also have a higher CCI. 12 Further work is needed to understand the differences between ED and ward referrals, but our data suggest that expanding the pool of ED referrals may be safe and effective.…”

Route and duration of antibiotic therapy in acute cellulitis: A systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment

“…Eleven studies, including those treated as outpatients/OPAT, reported an average length of IV therapy of 2-7 days and an average overall treatment duration of 6-10 days. [59][60][61][62][63][64][65][66][67][68][69] Clinical response rates ranged from 85-97%, failure rates from 5-22% and recurrence rates from 0-6%.…”

“…In studies comparing patients with better versus worse outcomes, groups with poorer outcomes had higher proportions of patients with prior cellulitis, sepsis at presentation and comorbidities (including diabetes, immunosuppression, obesity and venous insufficiency). 40,48,50,55,60,62 With regards to treatment-associated harms, data on adverse events were not reported separately for cellulitis patients within SSTI trials, but overall, three trials found a higher incidence of gastrointestinal side-effects among patients receiving longer treatment (linezolid and erythromycin) versus shorter treatment (tedizolid and azithromycin). 29,32,33 One trial found no difference in gastrointestinal side effects between groups.…”