Ailbhe Kiely1,2, Sami Abd Elwahab3, Declan McDonnell3, Roisin Tully3, Maria Randles4, Mary Hickey5, Felix Ofori-Kuma3, Ivan Ivanovski3, Suhail Khan3, Karl Schmidt3, Kenneth Mealy3. 1. Department of Plastic Surgery, St Thomas's Hospital, Westminster Bridge Road, London, SE1 7EH, UK. kielya1@tcd.ie. 2. Department of Surgery, Wexford General Hospital, Wexford, Ireland. kielya1@tcd.ie. 3. Department of Surgery, Wexford General Hospital, Wexford, Ireland. 4. Antimicrobial Pharmacist, Wexford General Hospital, Wexford, Ireland. 5. Department of Microbiology, Southeast Health Board, University Hospital Waterford, Waterford, Ireland.
Abstract
BACKGROUND/AIMS: Application of evidence-based guidelines in the management of cellulitis is poorly studied in Ireland and it is observed that current admission and prescription practices in this country vary widely from internationally accepted standards of care. We aimed to examine the management of cellulitis with regard to hospital admission and initial antibiotic therapy. METHODS: A retrospective audit of patients admitted with cellulitis from 2013 to 2017 in an Irish district general hospital. Exclusion criteria included specialist regions of the body and surgical site infections. Appropriateness of admission and management was compared against international guidelines (Clinical Research Efficiency Support Team (CREST) and Infectious Disease Society of America (IDSA)). RESULTS: Five hundred twenty emergency admissions with cellulitis were analysed. Thirty-five percent (n = 182) were deemed inappropriate admissions compared with CREST and IDSA guidelines, with an estimated cost of €152,203 per annum. Ninety-six percent (n = 501) of patients with cellulitis were treated with a combination of flucloxacillin and benzylpenicillin, despite level 1 evidence showing combination therapy to provide no benefit over appropriate monotherapy. CONCLUSIONS: There is a significant discrepancy between current clinical practice and international guidelines for the management of cellulitis in Ireland; local guidelines are not in keeping with newer evidence and there is a lack of national guidelines for this common condition. Closer adherence to international guidelines would significantly reduce costs by reducing unnecessary admissions and initial monotherapy would improve antibiotic stewardship. This study shows a clear need for local institutions to re-examine antibiotic guidelines to ensure the HSE provides effective evidence-based treatment in the correct setting.
BACKGROUND/AIMS: Application of evidence-based guidelines in the management of cellulitis is poorly studied in Ireland and it is observed that current admission and prescription practices in this country vary widely from internationally accepted standards of care. We aimed to examine the management of cellulitis with regard to hospital admission and initial antibiotic therapy. METHODS: A retrospective audit of patients admitted with cellulitis from 2013 to 2017 in an Irish district general hospital. Exclusion criteria included specialist regions of the body and surgical site infections. Appropriateness of admission and management was compared against international guidelines (Clinical Research Efficiency Support Team (CREST) and Infectious Disease Society of America (IDSA)). RESULTS: Five hundred twenty emergency admissions with cellulitis were analysed. Thirty-five percent (n = 182) were deemed inappropriate admissions compared with CREST and IDSA guidelines, with an estimated cost of €152,203 per annum. Ninety-six percent (n = 501) of patients with cellulitis were treated with a combination of flucloxacillin and benzylpenicillin, despite level 1 evidence showing combination therapy to provide no benefit over appropriate monotherapy. CONCLUSIONS: There is a significant discrepancy between current clinical practice and international guidelines for the management of cellulitis in Ireland; local guidelines are not in keeping with newer evidence and there is a lack of national guidelines for this common condition. Closer adherence to international guidelines would significantly reduce costs by reducing unnecessary admissions and initial monotherapy would improve antibiotic stewardship. This study shows a clear need for local institutions to re-examine antibiotic guidelines to ensure the HSE provides effective evidence-based treatment in the correct setting.
Authors: Dennis L Stevens; Alan L Bisno; Henry F Chambers; E Patchen Dellinger; Ellie J C Goldstein; Sherwood L Gorbach; Jan V Hirschmann; Sheldon L Kaplan; Jose G Montoya; James C Wade Journal: Clin Infect Dis Date: 2014-06-18 Impact factor: 9.079
Authors: David R McNamara; Imad M Tleyjeh; Elie F Berbari; Brian D Lahr; Jeffrey Martinez; Sultan A Mirzoyev; Larry M Baddour Journal: Arch Intern Med Date: 2007-04-09
Authors: Richard Brindle; O Martin Williams; Paul Davies; Tim Harris; Heather Jarman; Alastair D Hay; Peter Featherstone Journal: BMJ Open Date: 2017-03-17 Impact factor: 2.692