Theofiles Meghan, Maxson Julie, Herges Lori, Marcelin Alberto, Angstman Kurt B
Mayo Clinic, Rochester, MN, USA
Mayo Clinic, Rochester, MN, USA.
J Prim Care Community Health. 2015 Oct;6(4):233-8. doi: 10.1177/2150131915583659. Epub 2015 Apr 29.
Cellulitis in obese patients is associated with increased rates of treatment failure compared to those with normal body mass index (BMI); however, patients have not been extensively studied in the outpatient environment or stratified based on range of obesity and associated risk factors. This study looked at antibiotic dosing and treatment failure in the obese population from the primary care perspective and accounts for BMI range, weight, comorbid diabetes, and tobacco use.
This study was a retrospective chart review of 637 adult primary care patients designed to evaluate rates of treatment failure of outpatient cellulitis among patients of varying BMI. Treatment failure was defined as (a) hospital admission for intravenous antibiotics, (b) prolonged antibiotic course, or (c) requiring a different antibiotic after initial course.
Adverse outcomes were not statistically significant between normal BMI and those with BMI ≥40 kg/m(2). A subset of patients with a BMI ≥50 kg/m(2) was noted to have approximately twice the rate of adverse outcomes as the normal BMI group. While controlling for age, gender, race, diagnosis of diabetes mellitus, and tobacco use, a BMI of ≥50 kg/m(2) and a weight ≥120 kg was associated with adverse outcomes with an odds ratio of 2.440 (95% CI, 1.260-4.724; P = .008) and 2.246 (95% CI, 1.154-4.369; P = .017), respectively.
Patients with cellulitis weighing >120kg or with a BMI ≥50 kg/m(2) were at greatest risk for treatment failure in the outpatient setting, even when controlling for comorbid diabetes and tobacco use. As morbid obesity continues to become more prevalent, it becomes imperative that primary care physicians have better antibiotic dosing guidelines to account for the physiologic effects of obesity to minimize the risk of increased morbidity, health care costs, and antibiotic resistance.
与体重指数（BMI）正常的患者相比，肥胖患者的蜂窝织炎治疗失败率更高；然而，尚未在门诊环境中对患者进行广泛研究，也未根据肥胖范围和相关危险因素进行分层。本研究从初级保健的角度观察肥胖人群的抗生素剂量和治疗失败情况，并考虑了BMI范围、体重、合并糖尿病和吸烟情况。
本研究是一项对637例成年初级保健患者的回顾性病历审查，旨在评估不同BMI患者门诊蜂窝织炎的治疗失败率。治疗失败定义为：（a）因静脉使用抗生素而住院；（b）抗生素疗程延长；或（c）初始疗程后需要更换抗生素。
正常BMI患者与BMI≥40kg/m²的患者之间的不良结局无统计学差异。注意到BMI≥50kg/m²的一部分患者的不良结局发生率约为正常BMI组的两倍。在控制年龄、性别、种族、糖尿病诊断和吸烟情况后，BMI≥50kg/m²和体重≥120kg与不良结局相关，优势比分别为2.440（95%CI，1.260 - 4.724；P = 0.008）和2.246（95%CI，1.154 - 4.369；P = 0.017）。
蜂窝织炎患者体重>120kg或BMI≥50kg/m²在门诊环境中治疗失败风险最高，即使在控制合并糖尿病和吸烟情况时也是如此。随着病态肥胖的患病率持续上升，初级保健医生必须有更好的抗生素剂量指南，以考虑肥胖的生理影响，将发病率增加、医疗保健成本和抗生素耐药性风险降至最低。
