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Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors

View Article: PubMed Central - PubMed

ABSTRACT

In this prospective study of cellulitis, several nonpharmacological factors were associated with lack of early response. Such early nonresponse was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment often may be premature.

No MeSH data available.


Clinical and biochemical response at days 1, 2, and 3. Response evaluation was based on comparison with findings the day before. Response at days 2 and 3 was defined as response by day 2 and 3, respectively. See the “Methods” section for further details. A, Different clinical and biochemical response parameters are presented. ΔBody temperature ≤37.5°C in ≥2 separate measurements in 1 day (≥1 measurement if discharged) among cases with temperature >37.5°C the day before. ₸Not based on comparison with the day before but compared to the maximum value of all preceding days in hospital. B, Clinical and/or biochemical response using combined parameters. Clinical response was defined as cessation of lesion spread and overall improvement of local inflammation from one day to the next. Biochemical response was defined as at least 20% reduction of blood leukocytes or C-reactive protein (CRP) from one day to the next. The number of cases with indeterminate response (≥1 response parameter missing) at days 1, 2, and 3 were 16, 28, and 24, respectively. Abbreviations: Biochem+, biochemical response; Biochem-, no biochemical response; Clin+, clinical response; Clin-, no clinical response.
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CIW463F1: Clinical and biochemical response at days 1, 2, and 3. Response evaluation was based on comparison with findings the day before. Response at days 2 and 3 was defined as response by day 2 and 3, respectively. See the “Methods” section for further details. A, Different clinical and biochemical response parameters are presented. ΔBody temperature ≤37.5°C in ≥2 separate measurements in 1 day (≥1 measurement if discharged) among cases with temperature >37.5°C the day before. ₸Not based on comparison with the day before but compared to the maximum value of all preceding days in hospital. B, Clinical and/or biochemical response using combined parameters. Clinical response was defined as cessation of lesion spread and overall improvement of local inflammation from one day to the next. Biochemical response was defined as at least 20% reduction of blood leukocytes or C-reactive protein (CRP) from one day to the next. The number of cases with indeterminate response (≥1 response parameter missing) at days 1, 2, and 3 were 16, 28, and 24, respectively. Abbreviations: Biochem+, biochemical response; Biochem-, no biochemical response; Clin+, clinical response; Clin-, no clinical response.

Mentions: At day 1, 55% of evaluable cases (116/211) had cessation of lesion spread, and 52% (109/211) had improvement of local inflammation (Figure 1A), but 16% (34/211) had cessation only, and 13% (27/211) had improvement of inflammation only. Local clinical response defined by a combination of these 2 events was seen in 39% (82/212). Local clinical response or biochemical response was observed at day 1 in 74% (148/200) of cases (Figure 1B).Figure 1.


Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors
Clinical and biochemical response at days 1, 2, and 3. Response evaluation was based on comparison with findings the day before. Response at days 2 and 3 was defined as response by day 2 and 3, respectively. See the “Methods” section for further details. A, Different clinical and biochemical response parameters are presented. ΔBody temperature ≤37.5°C in ≥2 separate measurements in 1 day (≥1 measurement if discharged) among cases with temperature >37.5°C the day before. ₸Not based on comparison with the day before but compared to the maximum value of all preceding days in hospital. B, Clinical and/or biochemical response using combined parameters. Clinical response was defined as cessation of lesion spread and overall improvement of local inflammation from one day to the next. Biochemical response was defined as at least 20% reduction of blood leukocytes or C-reactive protein (CRP) from one day to the next. The number of cases with indeterminate response (≥1 response parameter missing) at days 1, 2, and 3 were 16, 28, and 24, respectively. Abbreviations: Biochem+, biochemical response; Biochem-, no biochemical response; Clin+, clinical response; Clin-, no clinical response.
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CIW463F1: Clinical and biochemical response at days 1, 2, and 3. Response evaluation was based on comparison with findings the day before. Response at days 2 and 3 was defined as response by day 2 and 3, respectively. See the “Methods” section for further details. A, Different clinical and biochemical response parameters are presented. ΔBody temperature ≤37.5°C in ≥2 separate measurements in 1 day (≥1 measurement if discharged) among cases with temperature >37.5°C the day before. ₸Not based on comparison with the day before but compared to the maximum value of all preceding days in hospital. B, Clinical and/or biochemical response using combined parameters. Clinical response was defined as cessation of lesion spread and overall improvement of local inflammation from one day to the next. Biochemical response was defined as at least 20% reduction of blood leukocytes or C-reactive protein (CRP) from one day to the next. The number of cases with indeterminate response (≥1 response parameter missing) at days 1, 2, and 3 were 16, 28, and 24, respectively. Abbreviations: Biochem+, biochemical response; Biochem-, no biochemical response; Clin+, clinical response; Clin-, no clinical response.
Mentions: At day 1, 55% of evaluable cases (116/211) had cessation of lesion spread, and 52% (109/211) had improvement of local inflammation (Figure 1A), but 16% (34/211) had cessation only, and 13% (27/211) had improvement of inflammation only. Local clinical response defined by a combination of these 2 events was seen in 39% (82/212). Local clinical response or biochemical response was observed at day 1 in 74% (148/200) of cases (Figure 1B).Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

In this prospective study of cellulitis, several nonpharmacological factors were associated with lack of early response. Such early nonresponse was rarely related to inappropriate therapy but strongly predictive of early treatment escalation, suggesting that broadening antibiotic treatment often may be premature.

No MeSH data available.