Williams O Martin, Hamilton Fergus, Brindle Richard
UK Health Security Agency Microbiology Laboratory Services Bristol, Bristol Royal Infirmary, Bristol, UK.
University Hospitals and Weston NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK.
Open Forum Infect Dis. 2023 Sep 29;10(10):ofad488. doi: 10.1093/ofid/ofad488. eCollection 2023 Oct.
Although cellulitis is a relatively common skin infection, there remains uncertainty about management, particularly the length and route of antimicrobials required. Further information on the symptomatology and biomarker changes associated with cellulitis over time would guide clinicians and patients as to the expected natural history.
We extracted data from a randomized clinical trial (NCT01876628) of clindamycin as adjunctive therapy in cellulitis to illustrate the evolution of local parameters (pain, swelling, local erythema, and warmth) and the resolution of biomarkers over time.
Data from 247 individuals with mild to moderate unilateral lower limb cellulitis, who attended at least 1 face-to-face interview following recruitment, were used to examine response dynamics. Although there was a local improvement in swelling, warmth, erythema, and pain by day 5 compared with baseline, some individuals still had evidence of local inflammation at 10 days. Most biomarkers demonstrated a return to normal by day 3, although the initial fall in albumin only returned to baseline by day 10.
Although there was initial resolution, a significant number of individuals still had local symptoms persisting to day 10 and beyond. Clinicians can use these data to reassure themselves and their patients that ongoing local symptoms and signs after completion of antibiotic treatment do not indicate treatment failure or warrant extension of the initial antibiotic treatment or a change in antibiotic class or mode of administration.
尽管蜂窝织炎是一种相对常见的皮肤感染，但在治疗管理方面仍存在不确定性，尤其是所需抗菌药物的疗程和给药途径。关于蜂窝织炎随时间变化的症状学和生物标志物变化的更多信息，将有助于临床医生和患者了解其预期的自然病程。
我们从一项关于克林霉素作为蜂窝织炎辅助治疗的随机临床试验（NCT01876628）中提取数据，以说明局部参数（疼痛、肿胀、局部红斑和皮温）的变化以及生物标志物随时间的消退情况。
对247例轻度至中度单侧下肢蜂窝织炎患者的数据进行分析，这些患者在招募后至少参加了1次面对面访谈，以检查反应动态。与基线相比，第5天时肿胀、皮温、红斑和疼痛有局部改善，但部分患者在第10天时仍有局部炎症迹象。大多数生物标志物在第3天时恢复正常，尽管白蛋白最初下降至第10天才恢复到基线水平。
尽管初期症状有所缓解，但仍有相当数量的患者局部症状持续至第10天及以后。临床医生可以利用这些数据向自己和患者保证，抗生素治疗结束后持续存在的局部症状和体征并不表明治疗失败，也无需延长初始抗生素治疗时间、更换抗生素类别或给药方式。
