Evaluating Risk Factors for Short Versus Long Hospital Stay for Cellulitis to Guide the Development of a Long-acting...

Area of Science:

• Infectious Diseases
• Pharmacology
• Health Services Research

Background:

• Cellulitis is a frequent cause of hospitalization, straining healthcare resources.
• Current treatment decisions for cellulitis often rely on expert opinion rather than robust evidence, particularly concerning long-acting lipoglycopeptides (LaLGPs).
• Limited data exists to guide the use of LaLGPs for reducing cellulitis-related hospitalizations.

Purpose of the Study:

• To identify patient-specific risk factors for short-stay hospitalizations (<72 hours) in cellulitis patients.
• To inform the development of a decision algorithm for emergency department (ED) use of LaLGPs.
• To potentially decrease cellulitis hospitalization rates through targeted interventions.

Main Methods:

• Adult patients receiving antibiotic monotherapy for cellulitis were analyzed.
• Patients were categorized into three groups: ED discharge, short-stay (<72 hours), and long-stay (≥72 hours) hospitalization.
• Exclusion criteria included surgical intervention, polymicrobial therapy, ICU admission, recent cellulitis treatment, or multiple infections.

Main Results:

• Fever was the sole factor independently associated with short-stay hospitalization compared to ED discharge (OR 32.7).
• Advancing age and need for incision and drainage also showed associations with short-stay admissions.
• Diabetes (OR 3.02), purulence (OR 3.86), and a history of methicillin-resistant Staphylococcus aureus (MRSA) (OR 4.31) were linked to longer hospital stays.

Conclusions:

• Fever is a key indicator for short-stay hospitalization in cellulitis cases.
• Specific factors like diabetes, purulence, and MRSA history predict prolonged hospitalizations.
• Integrating these findings into an ED decision algorithm could optimize LaLGP use and reduce overall cellulitis hospitalizations.