Infectiologie, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice, France.
Faculté de Médecine, Université de Nice Sophia-Antipolis, Nice, France.
Eur J Clin Microbiol Infect Dis. 2019 Apr;38(4):703-709. doi: 10.1007/s10096-019-03490-6. Epub 2019 Jan 26.
Outside areas of S. aureus strains resistant to methicillin (MRSA) in the community, no studies showed a relationship between the treatment for erysipelas or cellulitis and the outcome. We aimed to measure the impact of an internal therapeutic protocol, based on national guidelines on patients' outcome. This study was based on the dashboard of the infectious diseases department, which prospectively includes 28 parameters for all admitted patients. We included community-acquired erysipelas and cellulitis; exclusion criteria were abscesses at admission; ear, nose, throat, or dental cellulitis; pyomyositis; and length of stay ≤ 2 days. Adherence to guidelines was defined by the use of amoxicillin, amoxicillin/clavulanic acid, clindamycin, or pristinamycin, alone or in combination or successively. A poor outcome was defined by surgical procedure or intensive care requirement or death occurring after 5 days or more of antibiotic therapy. From July 2005 to June 2017, 630 cases of erysipelas or cellulitis were included. Blood cultures performed in 567 patients (90%) were positive in 39 cases (6.9%). Adherence rate to guidelines was 65% (410 cases). A poor outcome was recorded in 54 (8.5%) patients, less frequently in case of adherence to guidelines: 26/410 (6.3%) vs 28/220 (12.7%), p = 0.007. In logistic regression analysis, two risk factors were associated with a poor outcome: peripheral arterial disease, AOR 4.80 (2.20-10.49); and bacteremia, AOR 5.21 (2.31-11.76), while guideline adherence was the only modifiable protective factor, OR 0.48 (0.26-0.89). In erysipelas and cellulitis, adherence to guidelines was associated with a favorable outcome.
在社区中耐甲氧西林金黄色葡萄球菌（MRSA）菌株的非流行区域，没有研究表明治疗丹毒或蜂窝织炎与结局之间存在关系。我们旨在根据国家指南衡量基于内部治疗方案对患者结局的影响。这项研究基于传染病科的仪表板，该仪表板前瞻性地包括所有住院患者的 28 个参数。我们纳入了社区获得性丹毒和蜂窝织炎；排除标准为入院时的脓肿；耳部、鼻部、喉部或牙科蜂窝织炎；肌脓肿；以及住院时间≤2 天。指南的依从性定义为单独或联合使用阿莫西林、阿莫西林/克拉维酸、克林霉素或普林霉素，或先后使用。不良结局定义为发生抗生素治疗 5 天或以上后需要手术或重症监护或死亡。2005 年 7 月至 2017 年 6 月，共纳入 630 例丹毒或蜂窝织炎患者。对 567 例患者（90%）进行的血培养中，39 例（6.9%）阳性。指南的依从率为 65%（410 例）。54 例（8.5%）患者记录为不良结局，而遵医嘱治疗的患者中不良结局较少：410 例中有 26 例（6.3%），220 例中有 28 例（12.7%），p=0.007。在逻辑回归分析中，两个危险因素与不良结局相关：周围动脉疾病，OR 4.80（2.20-10.49）；和菌血症，OR 5.21（2.31-11.76），而遵医嘱是唯一可改变的保护因素，OR 0.48（0.26-0.89）。在丹毒和蜂窝织炎中，遵医嘱与良好结局相关。
