Early Dermatologic Consultation in Presumed Cellulitis May Improve Outcomes

Early dermatologic consultation in patients hospitalized with presumed cellulitis has been shown to improve outcome and decrease the length of intravenous (IV) antibiotic use, according to the results of a randomized clinical trial conducted in a large urban tertiary care hospital and published in JAMA Dermatology.

The investigators sought to determine whether dermatologic consultations reduce the length of hospital stay and IV antibiotic treatment duration among patients with cellulitis. The current study, which was conducted between October 2012 and January 2017, with a 1-month follow-up, enrolled a total of 175 patients.

Participants were randomly assigned to the control group (n=87), which received standard-of-care treatment, or to the intervention group (n=88), which received dermatologic consultations.

Of the 175 study enrollees, 60% were men. The mean patient age was 58.8 years. The length of hospital stay was slightly shorter in the intervention group vs the control group (<4 days: 76.2% vs 64.4%, respectively), but this difference was not statistically significant.

The duration of IV antibiotic treatment was significantly lower among patients who underwent early dermatologic consultation (<4 days: 85.2% vs 74.7%, respectively; absolute difference 10.5%; 95% CI, 0.5%-20/5%; P =.04).     

The mean number of antibiotics used in the control group was significantly higher than the number used in the intervention group (2.8 vs 2.5, respectively; absolute difference 0.3; 95% CI, 0.02-0.58; P =.04). Moreover, the duration of total antibiotic treatment was also significantly lower among patients in the intervention group (<10 days; 50.6% vs 32.5%, respectively; absolute difference 18.1%; 95% CI, 3.7%-32.5%; P =.01).

Clinical improvement at 2 weeks was significantly higher among those in the intervention group compared with the control group (89.3% vs 68.3%, respectively; absolute difference 21.0%; 95% CI, 9.3%-32.7%; P <.001).

The investigators concluded that involvement of inpatient dermatology services may enhance patient outcomes by improving diagnostic accuracy and promoting antibiotic management among patients who are hospitalized with suspected cellulitis.

Reference

Ko LN, Garza-Mayers AC, St John J, et al. Effect of dermatology consultation on outcomes for patients with presumed cellulitis: a randomized clinical trial [published online February 16, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2017.6196