Case survey of management of cellulitis in a tertiary teaching hospital.

OBJECTIVE

To examine management of cellulitis in a tertiary teaching hospital, identify inefficiencies and suggest revised management guidelines.

DESIGN

Retrospective case survey, based on patient hospital records.

SETTING

Heidelberg Repatriation Hospital, Melbourne, Victoria (a tertiary teaching hospital), in 1991 and 1992.

SUBJECTS

All patients admitted with lower-limb cellulitis as the primary diagnosis.

RESULTS

118 patients were included. Underlying disease predisposing to cellulitis was found in 79%, but was adequately investigated in only 20% of these. Blood cultures were performed in 55%, all with negative results. Other microbiological investigations also had poor yields. Combination therapy with intravenous (i.v.) flucloxacillin and penicillin was given to 76%, with duration varying widely (mean, six days). Where documented (73%), most patients (94%) responded to antibiotics within five days. However, in 40% of patients i.v. therapy was continued for longer and in 10% for 10 days or more, with no significant difference in outcome. Length of hospital stay averaged 13 days, with prolonged stay often associated with surgical intervention or intercurrent problems. However, 15% of patients remained in hospital longer than 10 days for no clear indication. Outpatient review was common (75%), but persistence or relapse of cellulitis was found in only four patients on review.

CONCLUSIONS

Management of inpatients with cellulitis is inefficient, with excessive use of microbiological investigations, inadequate investigation and treatment of underlying disease, prolonged use of intravenous antibiotics, unnecessarily long hospital stays, questionable use of combination antibiotic therapy and excessive outpatient review (rather than review by a local medical practitioner).