The risk factors of lower limb cellulitis in hospitalized patients at UKM Medical Centre: a case control study

Abstract

Introduction Lower limb cellulitis is a common superficial skin infection which may lead to morbidity and mortality. Risk factors of cellulitis are well studied. However, its relevance is rarely evaluated in case-control study in Malaysia. Regional variations of these risk factors have never been assessed and it may be different from other studies around the globe. The identification of preventable risk factors is important in order to improve patient’s management and thus lighten the health care burden. Objectives To determine the risk factors of lower limb cellulitis amongst patients admitted to UKM Medical Centre. Methods This was a prospective case control study carried out at UKM Medical Centre involving patients admitted to all wards with the clinical diagnosis of lower limb cellulitis from January to August 2015. Each case patient was compared to two age and gender matched control patients. The cellulitis patients were followed until the day of discharge, with particular attention on risk factors, empirical antibiotics precsribed by the managing doctors and complications of lower limb cellulitis. Results A total of 96 cellulitis patients and 192 controls participated in this study. The cellulitis patients consisted of 61 male and 35 female with mean age of 62.07±15.43 years. 76.1% of them had 1st episode of cellulitis. Multivariate analysis showed previous history of cellulitis (OR, 25.53; 95% CI, 4.73-137.79), sole anomalies (OR, 16.32; 95%CI, 6.65-40.06), ulceration (OR, 14.86; 95%CI, 1.00-219.39), venous insufficiency (OR, 10.46 95% CI, 1.98-55.22), interdigital intertrigo (OR, 8.86; 95%CI, 3.33-23.56), eczema (OR, 5.74; 95% CI, 0.96.-34.21), and limb edema (OR, 3.95; 95%CI, 1.82-8.59) had strong association with cellulitis. Penicillin was the commonly prescribed antibiotic (83.3%) to treat lower limb cellulitis, which is in line with the recommended guidelines. 24.5% of lower limb cellulitis patients developed complications with acute kidney injury and wound debridement being the most common complications. There were 3 cellulitis related mortality. Conclusion Previous cellulitis and local factors causing skin barrier disruption such as sole anomalies, ulceration, venous insufficiency, eczema, intertrigo and limb edema are the significant risk factors for lower limb cellulitis. Our findings are consistent with other studies of risk factors for lower limb cellulitis.