Out Of Hospital And In Hospital Management Of Cellulitis Requiring Intravenous Therapy
Received 6 September 2019
Accepted for publication 6 November 2019
Published 29 November 2019 Volume 2019:12 Pages 447—453
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Scott Fraser
Bin S Ong,1–3 Vincent Jiu Jong Ngian,1,2 Clarence Yeong,1 Caitlin Keighley1
1Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia; 2University of New South Wales, Sydney, NSW, Australia; 3Department of Ambulatory Care, Bankstown-Lidcombe Hospital, Bankstown, NSW 2200, Australia
Correspondence: Bin S Ong
Department of Ambulatory Care, Bankstown-Lidcombe Hospital, Eldridge Road, Bankstown, NSW 2200, Australia
Tel +61 2 97228637
Background: Cellulitis requiring intravenous therapy can be managed via out of hospital programs, but a high number of patients are still admitted to hospital.
Objective: We aimed to review the clinical features, management and outcomes of patients with cellulitis requiring intravenous therapy in a Hospital in the Home (HITH) program compared to patients who are admitted to hospital.
Methods: A prospective cohort study of patients with limb cellulitis requiring intravenous antibiotics was conducted at a metropolitan principal referral hospital.
Results: A total of 100 patients out of 113 eligible patients were recruited. Forty-eight were treated entirely in hospital and 52 were treated entirely or partially via HITH. Patients treated in hospital were older (mean 69.2 vs 56.7 years, p<0.001), less mobile, have more comorbidities (Charlson Comorbidity Index mean 2.2 vs 1.2, P=0.005) and more associated active illness. All patients with Eron Class III were admitted to hospital. Patients treated in hospital had a higher incidence of acute renal failure (27.1% vs 3.8%, p=0.001), nosocomial infection (10.4% vs 0.0%, P=0.023), and a higher 28-day hospital readmission rate (10.4% vs 0.0%, P=0.023).
Conclusion: Approximately half of the patients who require intravenous therapy can be treated via an out of hospital program. Patients admitted to hospital were more unwell and more likely to suffer complications. The presence of comorbid illness does not necessarily exclude participation in HITH and careful selection is essential to ensure safe outcomes.
Keywords: cellulitis, hospital in the home, outpatient parenteral antimicrobial therapy
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