Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors.
Clin Infect Dis. 2016 Jul 11;
Authors: Bruun T, Oppegaard O, Hufthammer KO, Langeland N, Skrede S
Abstract
BACKGROUND: Skin and soft tissue infections are common reasons for medical care. Use of broad-spectrum therapy and costs has increased. Assessment of early treatment response has been given a central role both in clinical trials and everyday practice. However, there is a paucity of data on the dynamics of response, causes of early non-response, and on how early non-response affects resource use and predicts outcome.
METHODS: We prospectively enrolled 216 patients hospitalized with cellulitis. Clinical and biochemical response data during the first three days of treatment were analyzed in relation to baseline factors, antibiotic use, surgery, and outcome. Multivariable analysis included logistic lasso regression.
RESULTS: Clinical or biochemical response was observed in the majority of patients already the day after treatment initiation. Concordance between clinical and biochemical response was strongest at day 2 and 3. Female gender, cardiovascular disease, higher body mass index, shorter duration of symptoms, and cellulitis other than typical erysipelas were predictors of non-response day 3. In contrast, baseline factors were not predictive of clinical failure assessed post-treatment. Among cases with antibiotic treatment escalation within day 2, 90% (37/41) had non-response day 1, but only 5% (2/40) had inappropriate initial therapy. Non-response day 3 was a predictor of treatment duration exceeding 14 days, but not of clinical failure.
CONCLUSION: Non-pharmacological factors had a major impact on early response dynamics. Delayed response was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment often may be premature.
PMID: 27402819 [PubMed - as supplied by publisher]