Department of Infectious Diseases, Auckland District Health Board, Auckland, New Zealand.
Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Clin Infect Dis. 2021 Sep 7;73(5):859-865. doi: 10.1093/cid/ciab181.
The Dundee classification of cellulitis severity, previously shown to predict disease outcomes, provides an opportunity to improve the management of patients with cellulitis.
We developed and implemented a pathway to guide the management of adults with cellulitis based on their Dundee severity class, and measured its effect on patient outcomes. We compared the outcomes in patients admitted to Auckland City Hospital (ACH) between July 2014 and July 2015 (the baseline cohort) with those in patients admitted between June 2017 and June 2018 (the intervention cohort).
The median length of stay was shorter in the intervention cohort (0.7 days, interquartile range (IQR) 0.1 to 3.0 days) than in the baseline cohort (1.8 days, IQR 0.1 to 4.4 days; P < .001). The 30-day mortality rate declined from 1.8% (19/1092) in the baseline cohort to 0.7% (10/1362; P = .02) in the intervention cohort. The 30-day cellulitis readmission rate increased from 6% in the baseline cohort to 11% (P < .001) in the intervention cohort. Adherence to the ACH cellulitis antibiotic guideline improved from 38% to 48% (P < .01) and was independently associated with reduced length of stay.
The implementation of the Auckland cellulitis pathway, readily generalizable to other settings, improved the outcomes in patients with cellulitis, and resulted in an annual saving of approximately 1000 bed days.
登迪分类法（Dundee classification）以前曾被证明可以预测蜂窝织炎的疾病结局，为改善蜂窝织炎患者的管理提供了机会。
我们制定并实施了一种基于登迪严重程度分类的成人蜂窝织炎管理途径，并测量其对患者结局的影响。我们比较了奥克兰城市医院（Auckland City Hospital，ACH）2014 年 7 月至 2015 年 7 月（基线队列）和 2017 年 6 月至 2018 年 6 月（干预队列）期间收治的患者的结局。
干预队列的中位住院时间较短（0.7 天，四分位距 0.1 至 3.0 天），短于基线队列（1.8 天，四分位距 0.1 至 4.4 天；P<0.001）。30 天死亡率从基线队列的 1.8%（19/1092）下降到干预队列的 0.7%（10/1362；P=0.02）。30 天蜂窝织炎再入院率从基线队列的 6%增加到干预队列的 11%（P<0.001）。ACH 蜂窝织炎抗生素指南的依从性从 38%提高到 48%（P<0.01），与住院时间缩短独立相关。
奥克兰蜂窝织炎途径的实施易于推广到其他环境中，改善了蜂窝织炎患者的结局，并每年节省约 1000 个床位日。
