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

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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.


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Flowchart of cases eligible for multivariable analyses to identify predictors of nonresponse at day 1 and day 3. Abbreviations: BMI, body mass index; SIRS, systemic inflammatory response syndrome.
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CIW463F3: Flowchart of cases eligible for multivariable analyses to identify predictors of nonresponse at day 1 and day 3. Abbreviations: BMI, body mass index; SIRS, systemic inflammatory response syndrome.

Mentions: Univariate analyses of factors possibly associated to nonresponse at days 1 and 3 are shown in Supplementary Table 2. Only cases without evidence of initial discordant therapy were entered into multivariable models to identify nonpharmacological predictors of early nonresponse (see flowchart in Figure 3). The adjusted lasso model identified no predictors of nonresponse at day 1 (Table 1). Antibiotic therapy prior to admission was not associated with decreased risk of nonresponse at day 1 or 3. As predictors of nonresponse at day 3, female sex, cardiovascular disease, higher body mass index, shorter symptom duration, and cellulitis other than typical erysipelas were identified. The model-based predicted probabilities of nonresponse at day 3 ranged from 2% to 42% (median, 8%; interquartile range, 5%–13%). The apparent AUC for the lasso model was 0.82. Leave-pair-out-cross-validation was used to correct for optimism, that is, to adjust for possible overestimation of the predictive ability of the model, reducing the AUC to 0.67. Sensitivity analysis with replacement of missing response data identified the same predictors (Supplementary Table 3).Table 1.


Early Response in Cellulitis: A Prospective Study of Dynamics and Predictors
Flowchart of cases eligible for multivariable analyses to identify predictors of nonresponse at day 1 and day 3. Abbreviations: BMI, body mass index; SIRS, systemic inflammatory response syndrome.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5036916&req=5

CIW463F3: Flowchart of cases eligible for multivariable analyses to identify predictors of nonresponse at day 1 and day 3. Abbreviations: BMI, body mass index; SIRS, systemic inflammatory response syndrome.
Mentions: Univariate analyses of factors possibly associated to nonresponse at days 1 and 3 are shown in Supplementary Table 2. Only cases without evidence of initial discordant therapy were entered into multivariable models to identify nonpharmacological predictors of early nonresponse (see flowchart in Figure 3). The adjusted lasso model identified no predictors of nonresponse at day 1 (Table 1). Antibiotic therapy prior to admission was not associated with decreased risk of nonresponse at day 1 or 3. As predictors of nonresponse at day 3, female sex, cardiovascular disease, higher body mass index, shorter symptom duration, and cellulitis other than typical erysipelas were identified. The model-based predicted probabilities of nonresponse at day 3 ranged from 2% to 42% (median, 8%; interquartile range, 5%–13%). The apparent AUC for the lasso model was 0.82. Leave-pair-out-cross-validation was used to correct for optimism, that is, to adjust for possible overestimation of the predictive ability of the model, reducing the AUC to 0.67. Sensitivity analysis with replacement of missing response data identified the same predictors (Supplementary Table 3).Table 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.


Related in: MedlinePlus