Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Stanford University, Stanford, CA, USA.
Arch Dermatol Res. 2024 Nov 30;317(1):61. doi: 10.1007/s00403-024-03515-x.
Cellulitis is a common skin infection often requiring antibiotic treatment. However, misdiagnosis and inappropriate antibiotic use contribute to antibiotic resistance and healthcare costs. We aimed to evaluate the impact of dermatology consultation on treatment modification in patients with suspected cellulitis and to determine whether dermatologists' evaluation can be used as a reference to diagnose suspected cellulitis. We explored MedLine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, and Scopus and Embase, including publications from database inception to July 25, 2023. Studies were included if they evaluated treatment modifications involving the use of antibiotics for patients with suspected cellulitis with and without dermatology consultation. We excluded comments or reviews, pilot studies, and studies without a non-dermatology control group, treatment modifications, the use of antibiotics, or patients with cellulitis. Of the 49 full-text articles, 14 studies met the selection criteria.This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Of five independent reviewers (GYC, IP, MG, MKH, and AMRP), two abstracted data for each article using a standardized abstraction form. We used the Downs and Black scale to evaluate study quality. Subgroup analysis was conducted regarding readmission rate within 30 days for two independent populations seen by a non-dermatologist physician or a dermatologist. We employed random-effects models to obtain pooled mean differences. Heterogeneity was assessed using the I-squared value. The impact of dermatology consultation on treatment modification involving antibiotics in patients with suspected cellulitis and readmission rates in 30 days. Dermatology consultation changed initial treatment plans involving antibiotics from 47 to 96% of the time, improving diagnostic accuracy and, consequently, antibiotic stewardship of cellulitis. Dermatology consultation was not significantly associated with lower readmission rates in 30 days (pooled OR = 0.56, 95% CI: 0.25 to 1.25, I2 = 0%). Dermatology consultation in patients with suspected cellulitis may improve diagnosis and management, thereby reducing antibiotic misuse, unnecessary tests, and prolonged hospitalizations.
蜂窝织炎是一种常见的皮肤感染，通常需要抗生素治疗。然而，误诊和不适当的抗生素使用导致了抗生素耐药性和医疗保健费用的增加。我们旨在评估皮肤科会诊对疑似蜂窝织炎患者治疗方案改变的影响，并确定皮肤科医生的评估是否可作为诊断疑似蜂窝织炎的参考。我们检索了 MedLine（PubMed）、Cumulative Index to Nursing and Allied Health Literature（CINAHL）、Cochrane CENTRAL、Web of Science 和 Scopus 以及 Embase，检索时间截至 2023 年 7 月 25 日。纳入的研究评估了有和没有皮肤科会诊的疑似蜂窝织炎患者在使用抗生素方面的治疗方案改变。我们排除了评论或综述、试点研究以及没有非皮肤科对照组、治疗方案改变、使用抗生素或蜂窝织炎患者的研究。在 49 篇全文文章中，有 14 项研究符合选择标准。本系统评价根据《系统评价和荟萃分析的首选报告项目》（PRISMA）声明和《观察性研究中的荟萃分析》（MOOSE）指南进行。5 名独立评审员（GYC、IP、MG、MKH 和 AMRP）每人对每篇文章的数据进行两次提取，使用标准化的提取表格。我们使用 Downs 和 Black 量表评估研究质量。对于由非皮肤科医生或皮肤科医生就诊的两个独立人群，我们进行了亚组分析，分析 30 天内再入院率。我们使用随机效应模型获取汇总平均差异。使用 I 平方值评估异质性。皮肤科会诊对疑似蜂窝织炎患者抗生素治疗方案改变和 30 天内再入院率的影响。皮肤科会诊将初始抗生素治疗方案的改变从 47%提高到 96%，提高了诊断准确性，从而改善了蜂窝织炎的抗生素管理。皮肤科会诊与 30 天内的低再入院率之间没有显著关联（汇总 OR=0.56，95%CI：0.25 至 1.25，I2=0%）。在疑似蜂窝织炎患者中进行皮肤科会诊可能会改善诊断和管理，从而减少抗生素滥用、不必要的检查和延长住院时间。
