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Risk factors and outcomes for community-acquired cellulitis caused by gram-negative bacilli



Risk factors and outcomes for community-acquired cellulitis caused by gram-negative bacilli



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 42: 365



Background: Few data are available regarding cellulitis caused by gram-negative bacilli (GNB). The aims of our study were to assess risk factors and outcomes for this infection. Methods: Review of medical records of all adult pts hospitalized for community-acquired cellulitis (Jan-95 to Dec-01). Cases complicating diabetic foot, orbital cellulitis, and drug addicts were excluded. Pts with GNB cellulitis were compared with pts with cellulitis due to gram-positive organisms. Results: There were 374 cases (197 female); mean age of 60 y. The infection was microbiologically documented in 140 cases (bacteremia 51, needle aspiration 76, surgical sample 32). The most frequently isolated pathogens were Staphylococcus aureus 47, Streptococcus pyogenes 24, Pseudomonas aeruginosa 16, and Escherichia coli 9. Overall, GNB were identified in 44 of 374 cases (12%) and gram-positive organisms in 86 cases. When comparing these groups, pts with GNB celulitis were older (63 vs 56 y) and had more frequently (p<.05) comorbidities (77% vs 52%), particularly hepatic cirrhosis (23% vs 9%) and congestive heart failure (23% vs 9%). Multivariate analysis identified age >than 60 y (OR 2.52) and hepatic cirrhosis (OR 1.96) as independent risk factors. Pts with GNB cellulitis had more frequently shock at presentation (21% vs 6%, p<.05) and received more often an inappropriate empirical antibiotic therapy (36% vs 5%; p<.01), mainly due to the lack of coverage against P. aeruginosa. Fourteen pts with GNB cellulitis required surgical debridement and 2 plastic surgery. Mortality (<30 d) in pts with GNB cellulitis was higher than that in pts with cellulitis due to gram-positive organisms (20% vs 7%; p=.023). Conclusions: GNB cellulitis occurs mainly in old pts with comorbidities, especially hepatic cirrhosis. It presents frequently with shock and causes high mortality. Empirical therapy of pts with cellulitis and shock should incorporate agents active against GNB, including P. aeruginosa.

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