Clinical Characteristics and Outcomes of Patients With Cellulitis Requiring Intensive Care

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Dermatology

Background:

• Cellulitis is a common skin infection, frequently seen in intensive care units (ICUs).
• Clinical features and outcomes of ICU-admitted cellulitis patients are not well-defined.
• Necrotizing fasciitis is often misdiagnosed as cellulitis and is more severe.

Purpose of the Study:

• To characterize the clinical presentation and outcomes of patients with cellulitis requiring ICU admission.
• To compare these patients with those diagnosed with necrotizing fasciitis.

Main Methods:

• A prospective cohort study was conducted across two tertiary hospitals in the Netherlands.
• Included 23 patients with severe cellulitis, 31 with necrotizing fasciitis, and 47 with other diagnoses from 2562 sepsis admissions.
• Data collected included patient demographics, disease characteristics, pathogens, ICU and hospital length of stay, and mortality.

Main Results:

• Cellulitis patients were less severely ill (lower shock rates, less mechanical ventilation) than necrotizing fasciitis patients.
• Cellulitis patients had more chronic comorbidities, particularly cardiovascular and immunodeficiency issues.
• Despite differences in severity and pathogens (Staphylococcus aureus more common in cellulitis, Streptococcus pyogenes in necrotizing fasciitis), mortality rates were similar.

Conclusions:

• While less critically ill upon ICU admission, patients with cellulitis present with more comorbidities compared to necrotizing fasciitis.
• Short-term and long-term mortality rates for cellulitis and necrotizing fasciitis in the ICU setting are comparable.
• Further research into the management of ICU-admitted cellulitis is warranted given the similar outcomes despite differing severity.