Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up

Cox, Neil

doi:10.1111/j.1365-2133.2006.07419.x

Cited by 124 publications

(97 citation statements)

References 13 publications

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“…Yatış sırasında tekrarlayan atağı olan hasta grubunda eşlik eden lenfödem oranı (%62,5), hiç lenfödemli hasta içermeyen ilk atak grubundan anlamlı olarak daha yüksekti. Hastaların %47'sinde tekrarlayan selülit atağı görülen bir araştırmada çalışmamıza benzer şekilde tekrarlayan ataklar ve bölgesel kronik ödem arasında anlamlı ilişki saptanmıştır (14). Dolayısıyla gerek bizim çalışmamız gerekse literatürdeki diğer veriler kronik lenfödemli hastalarda selülitin tekrarlama olasılığında artışa işaret etmektedir.…”

Section: Discussionunclassified

Retrospective Evaluation of Risk Factors and Response in Treatment among Hospitalized Patients with Lower-Extremity Cellulitis

Mehdi¹,

Ekinci²,

Baykal³

2016

tdd

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Amaç: Bacak yerleşimli selülit olgularında risk faktörlerinin ortaya çıkarılması, risk faktörlerinin tedaviye etkisinin araştırılması ve parenteral antibiyotik tedavisi uygulanan hastalarda tedavi etkinliği ve uygun tedavi süresi konusunda fikir sahibi olunmasıdır. Yöntemler: İstanbul Üniversitesi İstanbul Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı'nda, 2009-2014 yılları arasında yatırılarak tedavi edilen alt ekstremite selüliti tanılı 46 hastada enfeksiyon açısından olası risk faktörleri, yatış sırasında kullanılan tedaviler, sonuçları ve tedavi sonrası izlemeye alınan hastalarda nüks gelişimi retrospektif olarak değerlendirildi. Bulgular: Tinea pedis (n=19), diabetes mellitus (n=12), baypas cerrahisi (n=6) ve kronik lenfödem (n=5) risk faktörleri olarak saptandı. Takibi olmayan bir hasta dışındakilerin tümünde tam iyileşme saptandı. Hastaların 39'unda (%84,8) tek başına parenteral ampisilin-sulbaktam kullanıldı. İntravenöz antibiyotik tedavi süresi ortalama 17,7±12,4 gün (ortanca: 14 gün) olarak tespit edildi. Ortalama 2 yıllık izlem süresinde 11 hastada (%32,4) nüks saptandı ve tinea pedis ile nüks arasında anlamlı ilişki bulundu. Sonuç: Tinea pedis ve kronik lenfödem birden fazla atak oluşumunda risk faktörleri olarak saptandı. Parenteral antibiyotik tedavisi, bu amaçla da "tek başına ampisilin-sulbaktam" en sık kullanılan tedavi şekli olup alt ekstremite selülitinde çok yüksek oranda etkili bulundu. İyileşme için gerekli ortalama süre başka çalışmalara göre biraz uzun bulundu. Çalışmanın çoğunlukla dirençli ve komplike hastaların başvurduğu üçüncü basamak bir tedavi merkezinde gerçekleşmiş olması veya ülkemizdeki olası bir antibiyotik direnci bu sonuçta rol oynamış olabilir. Results: Tinea pedis (n=19), diabetes mellitus (n=12), by-pass surgery (n=6), and chronic lymphedema of the legs (n=5) were detected as main risk factors. Improvement with systemic therapy was seen in all patients except one patient who was lost to follow-up. Thirty nine of the patients (84.8%) were treated with parenteral ampicillin-sulbactam. The mean duration of parenteral antibiotic therapy was 17.7±12.4 (median: 14) days. In 11 patients (32.4%), recurrence was detected, during an average follow-up of 2 years. There was a significant correlation between tinea pedis and recurrence. Conclusion: Tinea pedis and chronic lymphedema were main risk factors for multiple attacks. Parenteral antibiotic treatment mostly used as the single drug regimen with ampicillinsulbactam was highly effective. Relatively longer duration of treatment in our patients has been attributed to the facts that being a tertiary medical center, dealing mostly with therapy resistant and high risk patients of cellulitis or antibiotic resistance in our country.

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Section: Discussionunclassified

Retrospective Evaluation of Risk Factors and Response in Treatment among Hospitalized Patients with Lower-Extremity Cellulitis

Mehdi¹,

Ekinci²,

Baykal³

2016

tdd

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“…As a risk factor for cellulitis, it is not clear whether it is the chronicity or severity of edema, or both, that is important. It is important to be aware that cellulitis is not only a consequence of edema, but that it also causes chronic edema, so that there is a vicious cycle leading to further episodes [20,26]. The effect of therapy to address these risk factors needs to be assessed.…”

Section: Methods Of Searchmentioning

confidence: 99%

Streptococcal Cellulitis/Erysipelas of the Lower Leg

Nambudiri

Bigby

2014

Evidence‐Based Dermatology

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“…In previous studies on about 2,000 patients with erysipelas of the lower leg, as well as in our control patients (data not shown), chronic venous insufficiency and lymphedema with 25% each were the most important predisposing conditions [5,9,13,27,33,34]. In the gluteal region, surgical impairment of the lymphatic circulation has been proposed to be a predisposing factor for erysipelas [16,17,22].…”

Section: Discussionmentioning

confidence: 99%

“…In the gluteal region, surgical impairment of the lymphatic circulation has been proposed to be a predisposing factor for erysipelas [16,17,22]. Lymph stasis after disruption of lymphatic vessels causes retention of high-molecular-weight proteins within the interstitial tissue leading to fibrosis with reduced tissue drainage capacity resulting in a vicious cycle [33,34]. This may also disturb the migration of dendritic cells [35], which could weaken the immunological response to pathogenic agents.…”

Section: Discussionmentioning

confidence: 99%

Erysipelas of the Thigh and the Gluteal Region: Retrospective Multicenter Analysis of a Very Rare Entity in 39 Patients

et al. 2012

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Background: Erysipelas of the thigh and the gluteal region are rarely described and not well characterized. Therefore we aim to describe the prevalence, clinical characteristics, and risk factors of these erysipelas types. Methods: The files of 1,423 patients with erysipelas were analyzed. Data from patients with erysipelas of the thigh or the gluteal region were compared between the two groups and with a control group with erysipelas of the lower leg. Results: The thigh was exclusively affected in 2.1%, and the gluteal region in 0.6% of erysipelas patients. Gluteal erysipelas had conspicuous irregular borders and sometimes appeared bilaterally. Major risk factors for erysipelas of both sites were previous surgical interventions. Gluteal erysipelas was common in patients with the metabolic syndrome and required a more intense antibiotic therapy. Conclusion: Erysipelas of the thigh and the gluteal region are rare and significantly associated with prior surgical disruption of lymphatic vessels.

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Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up

Cited by 124 publications

References 13 publications

Retrospective Evaluation of Risk Factors and Response in Treatment among Hospitalized Patients with Lower-Extremity Cellulitis

Retrospective Evaluation of Risk Factors and Response in Treatment among Hospitalized Patients with Lower-Extremity Cellulitis

Streptococcal Cellulitis/Erysipelas of the Lower Leg

Erysipelas of the Thigh and the Gluteal Region: Retrospective Multicenter Analysis of a Very Rare Entity in 39 Patients

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