Sanaz GHASHGHAEE3, Raheb GHORBANI, Mohammad NASSAJI

Risk factors of acute cellulitis in adult patients: A case-control study

Cellulitis is a common medical condition with different severity varies from mild to life threatening disease. The identification of preventable risk factors could reduce morbidity and mortality from this disease and improve patient management. The aim of this study was to identify the risk factors associated with cellulitis in adult patients. We conducted a case-control study of 102 adult subjects with cellulitis and the same number of controls who were admitted to two university affiliated hospitals. Data were obtained with a questionnaire and from examination of patients. Two groups were matched based on age (p=0.717) and gender (p=0.661). The most common site of cellulitis was lower extremities (56.9%). The pack-year smoking and duration of smoking was significantly higher in patients with cellulitis (p=0<001). Logistic regression analysis showed that recent trauma (OR=55.8, 95% CI: 11.2-278.4, p<0.001), history of recent surgery (OR=6.3, 95% CI:1.7-23.7, p=0.006), body mass index(OR=1.38, 95% CI:1.22-1.57, p<0.001) and diabetes mellitus(OR=3.02, 95% CI:1.17-7.81, p=0.022) was significantly associated with development of cellulitis. No association was observed between corticosteroid use and risk of cellulitis (p=0.158). Our study showed that the most important risk factors for cellulitis in adult include trauma, recent surgery, high body mass index, diabetes mellitus and smoking. Therefore, it is recommended that protection against trauma, controlling of blood glucose levels, reducing body weight and smoking cessation may lead to reducing incidence of cellulitis.

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1. Gunderson CG. Cellulitis: definition, etiology, and clinical features. Am J Med 2011; 124: 1113-1122.

2. Swartz MN. Clinical practice. Cellulitis. N Engl J Med 2004; 350: 904-912.

3. Bailey E, Kroshinsky D. Cellulitis: diagnosis and management. Dermatol Ther 2011; 24: 229-239.

4. Stevens DL, Eron LL. Cellulitis and soft-tissue infections. Ann Intern Med 2009; 150: ITC11.

5. Björnsdóttir S, Gottfredsson M, Thórisdóttir AS, et al. Risk factors for acute cellulitis of the lower limb: a prospective case-control study. Clin Infect Dis 2005; 41: 1416-1422.

6. Dupuy A, Benchikhi H, Roujeau JC, et al. Risk factors for erysipelas of the leg (cellulitis): casecontrol study. BMJ 1999; 318: 1591-1594.

7. Halpern J, Holder R, Langford NJ. Ethnicity and other risk factors for acute lower limb cellulitis: a U.K.-based prospective case-control study.Br J Dermatol 2008; 158: 1288-1292.

8. Mokni M, Dupuy A, Denguezli M, et al. Risk factors for erysipelas of the leg in Tunisia: a multicenter case-control study. Dermatology. 2006; 212: 108-112.

9. Koutica P, Mylonakis E, Boyce J. Cellulitis: evaluation of possible predisposing risk factors in hospitalized patients. Diagn Microbiol Infect Dis 1999; 34: 325-327.

10. Lazzarini L, Conti E, Tositti G, de Lalla F. Erysipelas and cellulitis: clinical and microbiological spectrum in an Italian tertiary care hospital. J Infect 2005; 51: 383-389.

11. Pavlotsky F, Amrani S, Trau H. Recurrent erysipelas: risk factors. J Dtsch Dermatol Ges 2004; 2: 89-95.

12. Perelló-Alzamora MR, Santos-Duran JC, Sánchez-Barba M, et al. Clinical and epidemiological characteristics of adult patients hospitalized for erysipelas and cellulitis. Eur J Clin Microbiol Infect Dis 2012; 31: 2147-2152.

13. Krasagakis K, Valachis A, Maniatakis P, et al. Analysis of epidemiology, clinical features and management of erysipelas. Int J Dermatol 2010; 49: 1012-1017.

14. Karppelin M, Siljander T, Vuopio-Varkila J, et al. Factors predisposing to acute and recurrent bacterial non-necrotizing cellulitis in hospitalized patients: a prospective case-control study. Clin Microbiol Infect 2010; 16: 729-734.

15. Roujeau JC, Sigurgeirsson B, Korting HC, Kerl H, Paul C. Chronic dermatomycoses of the foot as risk factors for acute bacterial cellulitis of the leg: a case-control study. Dermatology 2004; 209: 301-307.

16. Inghammar M, Rasmussen M, Linder A. Recurrent erysipelas--risk factors and clinical presentation. BMC Infect Dis 2014; 14: 270.

17. Lewis SD, Peter GS, Gomez-Marın O, Bisno AL. Risk factors for recurrent lower extremity cellulitis in a US Veterans medical center population. Am J Med Sci 2006; 332: 304-307.

18. Falagas ME, Kompoti M. Obesity and infection. Lancet Infect Dis 2006; 6: 438-446.

19. Milner JJ, Beck MA. The impact of obesity on the immune response to infection. Proc Nutr Soc 2012; 71: 298-306.

20. Teerachaisakul M, Ekataksin W, Durongwatana S, Taneepanichskul S. Risk factors for cellulitis in patients with lymphedema: a case-controlled study. Lymphology 2013; 46: 150-156.

21. Serdar ZA, Akçay SŞ, Inan A, Dağlı O. Evaluation of microbiological spectrum and risk factors of cellulitis in hospitalized patients. Cutan Ocul Toxicol 2011; 30: 221-224.

22. Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 2003; 26: 510-513.

23. Suaya JA, Eisenberg DF, Fang C, Miller LG. Skin and soft tissue infections and associated complications among commercially insured patients aged 0-64 years with and without diabetes in the U.S. PLoS One 2013; 8: 60057.

24. Jackson LA. Evaluating diabetes mellitus as a risk factor for community-acquired infections. Clin Infect Dis 2005; 41: 289-290.

25. Gupta S, Koirala J, Khardori R, Khardori N. Infections in diabetes mellitus and hyperglycemia. Infect Dis Clin North Am 2007; 21: 617-638.

26. Oumeish OY. Skin disorders in patients with diabetes. Clin Dermatol 2008; 26: 235-242.

27. Araco A, Gravante G, Sorge R, et al. Wound infections in aesthetic abdominoplasties: the role of smoking. Plast Reconstr Surg 2008; 121: 305-310.

28. Jain RK, Shukla R, Singh P, Kumar R. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery. Eur J Orthop Surg Traumatol 2015; 25: 251-254.

29. Lehr HA. Microcirculatory dysfunction induced by cigarette smoking. Microcirculation 2000; 7: 367-384.

30. Thomsen SF, Sørensen LT. Smoking and skin disease. Skin Therapy Lett 2010; 15: 4-7.

31. Kumar S, van Popta D, Rodrigues-Pinto R, et al. Risk factors for wound infection in surgery for spinal metastasis. Eur Spine J 2015; 24: 528- 532.