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PubMed2006

Recurrence of lymphoedema-associated cellulitis (erysipelas) under prophylactic antibiotherapy: a retrospective cohort study.

OBJECTIVE: To identify the predictors of successful antibiotic prophylactic treatment using benzathin-penicillin G to prevent recurrence of erysipelas in patients with secondary upper limb lymphoedema. DESIGN: A retrospective cohort study. SETTING AND PATIENTS: Patients with secondary arm lymphoedema were recruited in a single lymphology unit between 1990 and 2003. All patients had had at least three recurrences of erysipelas. Patients were given 2.4 MU benzathin-penicillin G intramuscularly at 14-day intervals. For each patient, the following data were recorded: characteristics of breast cancer treatment (type of surgery, radiotherapy, hormone therapy), number of erysipelas recurrences before inclusion, patient characteristics including body mass index (BMI) and lymphoedema volume at inclusion. MAIN OUTCOME MEASURES: The outcome studied was the occurrence of erysipelas on the affected arm under antibiotic prophylactic treatment. RESULTS: With a 4.2-year median follow-up from the onset of antibiotic prophylactic treatment, 23 of 48 women experienced recurrence of erysipelas. The median duration of erysipelas recurrence-free period under this treatment was 2.7 years. The estimated rate of recurrence was 26%[95% confidence interval (CI) 13-38%] at 1 year and 36% (95% CI 22-50%) at 2 years. No patient stopped the treatment because of side-effects. No predictive factor of erysipelas recurrence under antibiotic prophylactic treatment was identified. CONCLUSIONS: Antibiotic prophylaxis using benzathin-penicillin is a well-tolerated treatment of erysipelas recurrence in patients with upper limb lymphoedema secondary to breast cancer. The rate of erysipelas recurrence was 26% at 1 year in patients who had a history of at least one erysipelas. We did not find any predictor of erysipelas recurrence.

Adult↗
PubMed2003

Erysipelas: recognition and management.

Erysipelas is an acute bacterial infection of the dermis and hypodermis that is associated with clinical inflammation. It is a specific clinical type of cellulitis and, as such, it should be studied as a specific entity. Erysipelas is generally caused by group A streptococci; it is highly probable that streptococcal toxins also play a role, which could, in part, help explain the clinical inflammation. Erysipelas of the leg is the main clinical type encountered. The face, arm, and upper thigh are the other most common sites for the occurrence of erysipelas. After a sudden onset, areas of erythema and edema characteristically enlarge with well-defined margins. Athlete's foot is the most common portal of entry for the disease. Erysipelas is generally associated with high fever, and adenopathy and lymphangitis are sometimes present. At the time of diagnosis, it is important to look for clinical markers of severity (local signs and symptoms, general signs and symptoms, co-morbidity, social context) which would necessitate hospitalization. There are many differential diagnoses, particularly in the case of atypical dermo-hypodermitis. Some bacterial infections may have specific clinical aspects or may lead to a diagnosis of cellulitis. Necrotizing cellulitis or fasciitis are life-threatening diseases and a rapid diagnosis is important. Other noninfectious types of cellulitis have been reported in many diseases, both localized or generalized. The biology of typical erysipelas is of little value in diagnosis and a laboratory workup is usually not required. There are few local complications associated with erysipelas; abscess can occur in some patients and septicemia is rare. Recurrence is the more distressing complication. Treatment of patients with erysipelas has been evaluated in a small number of studies. In most of them, erysipelas has been included in therapeutic studies of 'severe cutaneous infections'. This is not justified as in fact erysipelas is usually sensitive to penicillin G. Amoxicillin and macrolides are also effective. However, comparative, cost-analysis studies need to be performed to determine the best therapeutic option. Bed rest with the leg elevated is also important. Anticoagulants are indicated in patients at risk of venous thromboembolism. The portal of entry will also require treatment. Long-term antibacterial therapy is required for patients with recurrence.

Anti-Bacterial Agents↗
PubMed2001

[100 years of erysipelas prophylaxis: significance and reduction of animal experiments].

The history of erysipelas prophylaxis began in 1882 when Pasteur first discovered the attenuating effect of rabbit passages on the erysipelas bacterium. Ten years later, the German veterinarian Lorenz demonstrated the protecting effect of erysipelas antiserum. He developed a method of serovaccination which was successfully used in Germany for more than 50 years. Both scientists employed laboratory animals for the development of their live vaccines. Lorenz additionally recommended an animal model with grey mice to control the potency of erysipelas sera. In 1944, Fortner and Dinter published the results of their investigation on a skin scarification test in swine. This modus of infection was the basis of the first reliable model for efficacy testing of erysipelas vaccines in domestic animals. Shortly after World War II, the first inactivated erysipelas vaccines were being developed. At that time, also a strict quality control was introduced for this product group which required extensive animal experiments in laboratory mice and pigs for the determination of efficacy. WHO established International Standards for erysipelas vaccines and antisera concerning potency testing in mice. These animal models were finally incorporated in pharmacopoeia monographs. Animal experiments have played an important role in the development and quality control of erysipelas vaccines. And the success of this quality control based on animal experiments has had a significant impact on the quality control systems for veterinary vaccines in general. Today, we have a far more detailed knowledge about pathogenesis and immunology of swine erysipelas. This knowledge now allows the introduction of alternative methods according to the 3R concept. With these new methods, animal numbers can be decreased and suffering caused by challenge infection can be reduced. The ultimate goal, i.e. quality control of erysipelas vaccines carried out without routine performance of animal experiments, should be achieved in the near future.

Animal Testing Alternatives↗
PubMed2004

Osteoarticular complications of erysipelas.

BACKGROUND: Rare osteoarticular complications occurring after erysipelas have been reported. We describe 9 patients in whom various osteoarticular complications developed during erysipelas. OBJECTIVE: We sought to analyze osteoarticular complications during erysipelas, paying special attention to clinical, bacteriologic, and radiologic data. METHODS: Data were retrospectively recorded from the files of patients seen in 3 dermatologic centers between 1998 and 2000. They included laboratory tests, bacteriologic cultures, radiologic investigations, and treatment modalities and outcome of both erysipelas and osteoarticular complications. RESULTS: We observed 9 patients (7 men and 2 women; mean age 49.6 years) who first presented with typical erysipelas of the lower limb and then osteoarticular complications developed during the course of their disease, always localized to a joint contiguous to the erysipelas plaque. These complications included: relatively benign complications, ie, bursitis (n = 5) or algodystrophy (n = 1), occurring after erysipelas with favorable course; and more severe complications, ie, osteitis (n = 1), arthritis (n = 1), and septic tendinitis (n = 1), occurring after erysipelas characterized by local cutaneous complications (abscess, necrosis). CONCLUSIONS: Osteoarticular complications of erysipelas can be divided into the 2 groups of nonseptic complications (mainly bursitis), which are characterized by a favorable outcome, and septic complications (osteitis, arthritis, tendinitis), which require specific, often prolonged treatment and, sometimes, operation. Their diagnosis is on the basis of clinical and radiologic findings rather than joint aspirations, which are usually not possible through infected skin tissue.

Adult↗
PubMed2002

[Hospitalization criteria for erysipelas: prospective study in 145 cases].

INTRODUCTION: Two recent studies conducted in France among general practitioners have shown that they only hospitalized between 20 to 50 percent of patients with erysipelas seen in private practice. We therefore conducted a hospital-based, prospective study designed to determine the hospitalization criteria for erysipelas, since a number of patients are also hospitalized directly through the emergency department. PATIENTS AND METHODS: This prospective, hospital-based study, included patients hospitalized for clinical diagnosis of erysipelas in 9 centres in north-eastern France. Clinical data were recorded using a standard questionnaire filled-in during the first 72 hours of hospitalization. They included: demographic (name and first name initials, age, sex) and clinical (location of erysipelas) characteristics, as well as the origin of the patient (home, emergency department, other department), the reasons for hospitalization (severity of local or systemic signs, suspicion of deep vein thrombosis, location on the face, age over 60 years, associated diseases, absence of improvement after ambulatory treatment, socioeconomic reasons or on principle hospitalization). Patients hospitalized by (or without) a general practitioner were compared using Chi-2 and Student t tests. RESULTS: One hundred forty-five adults (80 women and 65 men; mean age 61 +/- 20 years) were included in the study: 89 patients (61 p. 100) were hospitalized by a general practitioner whereas 56 (39 percent) went directly to the emergency department. In 128/145 cases (88 p. 100), erysipelas was localized on the lower limbs. The mean number of reasons for hospitalization per patient was of 2.2 +/- 1.2. The most frequent reason for hospitalization was an associated disease (diabetes, obesity, alcoholism, immunodeficiency), present in 77 cases (53 p. 100). Patients hospitalized through a general practitioner were older than those hospitalized directly through the emergency department (68 vs 51 years; p<0.001). Patients hospitalized by a general practitioner more frequently had an erysipelas located on the lower limbs (94 p. 100 vs 79 p. 100; p<0.001) and the mean number of reasons for hospitalization was greater (2.4 vs 1.7; p<0.001), especially suspicion of deep vein thrombosis and elevated mean age. The treatment started during hospitalization was intravenous penicillin G in 67 cases (46 p. 100), oral pristinamycin in 28 cases (19 p. 100) and intravenous or oral amoxicillin in 9 cases (6 p. 100). COMMENTS: This study demonstrates the existence of two distinct courses of hospitalization for erysipelas. Patients hospitalized by a general practitioner were older and their erysipelas more frequently located on the lower limbs and deep vein thrombosis was suspected. Our study also shows the emergence of a population of patients younger and without medical supervision, for whom the general practitioner is replaced by the emergency department of the local hospital. Nevertheless, the most frequent reason for hospitalization in both groups is the existence of an associated disease, possibly responsible for further complications.

Adult↗
PubMed2006

Bullous erysipelas: clinical presentation, staphylococcal involvement and methicillin resistance.

BACKGROUND: Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin. Bullous erysipelas represents a severe form of the disease. OBJECTIVE: To evaluate the clinical and microbiological characteristics and treatment of bullous erysipelas. METHODS: Patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, University Hospital of Heraklion, Crete, Greece, between the years 1996 and 2001 were retrospectively studied. RESULTS: Fourteen patients (11 women, 3 men) with bullous erysipelas were evaluated. The lesions were located on the legs and face in 9 and 4 patients, respectively. The median duration of disease before hospital admission was 4 days. Eight patients had fever at presentation. Local trauma and various lesions were common causes for pathogen entry. The initial empirical antibiotic treatment included intravenous beta-lactams and was modified according to the sensitivities of the isolated strains. Staphylococcus aureus was isolated from 7 (50%), while S. warneri, Streptococcus pyogenes and Escherichia coli grew from the lesions of 3 other patients. Six out of 7 S. aureus strains were methicillin resistant (MRSA) but susceptible to several other non-beta-lactam antibiotics such as quinolones, vancomycin, rifampicin and trimethoprim/sulfamethoxazole. CONCLUSION: Our findings suggest that S. aureus is frequently involved in and probably contributes in synergy with beta-hemolytic streptococci to the complicated course of bullous erysipelas. The frequency of MRSA isolation suggests that beta-lactam antibiotics may not be sufficient for the treatment of bullous erysipelas anymore, at least in areas with a high incidence of MRSA strains. The role of other classes of antibiotics providing adequate coverage for MRSA has to be evaluated in prospective clinical trials.

Adult↗
PubMed2006

Risk factors for erysipelas of the leg in Tunisia: a multicenter case-control study.

BACKGROUND: Risk factors for erysipelas (cellulitis) were rarely evaluated in controlled studies. Regional variations of these risk factors have never be assessed. OBJECTIVE: To assess risk factors for erysipelas of the leg in Tunisia. SUBJECTS AND METHODS: Case-control study in seven hospital centers in Tunisia. Cases were 114 consecutive patients with erysipelas of the leg [sudden onset (<24 h) of a well-demarcated dermo-hypodermatitis with fever or chills]. Two controls were matched to each case for age, sex, and hospital (n = 208). Main outcome measures are local and general suspected risk factors for erysipelas of the leg. RESULTS: In multivariate analysis, disruption of the cutaneous barrier (i.e. traumatic wound, toe-web intertrigo, excoriated leg dermatosis or plantar squamous lesions) and leg edema were independently associated with erysipelas of the leg, with respective odds ratios of 13.6 (95% confidence interval: 6.0-31) and 7.0 (1.3-38). No association was observed with diabetes, alcoholism, or smoking. CONCLUSIONS: We confirmed the major role of local risk factors and the minor role of general risk factors for erysipelas of the leg, in a setting different than the one previously studied. Detecting and treating toe-web intertrigo and traumatic wounds should be considered in the prevention of erysipelas of the leg.

Case-Control Studies↗
PubMed2001

[A prospective study on erysipelas and infectious cellulitis: how are they dealt within hospital?].

771 cases of erysipelas and 52 cases of infectious cellulitis were collected over 3 months in a prospective study carried out in French hospitals. The mean age was 62.7 +/- 19.3 years for the erysipelas patients and 69.7 +/- 16 years for the cellulitis patients. Sex-ratios were respectively 0.92 and 2.7. The infection was mainly localized in the lower limbs in both categories (90.9 p. 100 and 71 p. 100); the upper limbs and the face were more often involved in cellulitis than in erysipelas (13 p. 100 versus 5.2 p. 100 and 10 p. 100 versus 2.5 p. 100). Penicillin G was the initial antimicrobial treatment in 45 p. 100 of the erysipelas cases, whereas amoxicillin-clavulanic acid was used in 32.7 p. 100 of the cellulitis cases. Other antibiotics used were pristinamycin, antistaphylococcal penicillin, and amoxicillin. Combinations of antibiotics were used to treat 50 p. 100 of the cellulitis cases but only 11 p. 100 of the erysipelas cases. Anticoagulants were used in 67.4 p. 100 of the erysipelas cases and in 59.7 p. 100 of the cellulitis cases. Surgery was performed in 52 p. 100 of the cellulitis cases, and hyperbaric oxygen in 4.2 p. 100. The outcome was quite different for the 2 diseases: cure rate without complications reached 86.6 p. 100 for erysipelas, and only 48.1 p. 100 for cellulitis; death rates reached respectively 0.77 p. 100 and 5.7 p. 100, median length of hospitalization 8 days and 21 days, and median length of antibiotic treatment 15 days and 21 days.

Erysipelas↗
PubMed1999

[Cyclical intravenous antibiosis as an effective therapy concept in chronic recurrent erysipelas].

The treatment of choice for prevention of recurrent erysipelas is the long-term therapy with intramuscular penicillin. The results are often unsatisfactory. Usually erysipelas recurs when the treatment is stopped. The aim of the present study was to evaluate a new treatment regimen, consisting of intravenous penicillin combined with lymphatic drainage. Fifteen patients who had suffered from three or more episodes of erysipelas within the last two years received 10 Mega I.U. of penicillin per day over ten days every third month over a one year period (patients who were allergic to penicillin received erythromycin). Use of intravenous penicillin was combined with lymphatic drainage performed by a sequential pneumatic compressing device. The treatment results were assessed by clinical examination and laboratory tests as well as by laser Doppler imaging every third month. During the one year treatment period and a further year of follow-up, 14 of 15 patients had no recurrent erysipelas. Only a 65 year old patient suffering from Parkinson heart failure, chronic lymphedema and an extensive stasis ulcers had recurrent erysipelas. The present treatment regimen appears to be an effective therapy for prevention of recurrent erysipelas.

Adult↗
PubMed2005

[Erysipela after treatment of nasopharyngeal carcinoma].

PURPOSE: The aim of this work is to study the epidemiological, clinical and evolutive characteristics of the erysipela in patients treated for nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS: Between January 1993 and June 2003, 212 patients were treated for NPC in the radiotherapy department of Sfax hospital. Twenty-two patients among them have presented an erysipela. A neoadjuvant chemotherapy was used for 16 patients with N2-N3 disease. Locoregional radiotherapy was delivered for all of patients. RESULTS: The mean age was 35 years (range: 10 and 69), sex-ratio was 1.2. The median delay between the appearance of erysipela and the end of the treatment was 16 months. The main localisation was the face. The main clinical manifestations were fever in 86% of cases and erythema in 77% of cases. Immediate evolution was favorable in all cases after antibiotherapy. Recurrences were observed in 45% in cases. CONCLUSION: Erysipela is a common skin infection readly found in patients with venous insufficiency. In our study we found a significant correlation between the frequency of erysipela and dystrophic complications. The incidence of erysipela in the face and cervical region after radiotherapy is unknown.

Adolescent↗
PubMed2001

[Diagnostic criteria for erysipelas].

Diagnosis of erysipelas is based upon the association of an acute inflammatory plaque with fever, lymphagiitis, adenopathy and hyperleukocytosis. These associated symptoms are variable (20-70 p. 100 of cases). Bacteriology is not helpful for the diagnosis of erysipelas because of a low sensitivity (hemoculture 5 p. 100, standard examinations 5-41 p. 100), or delayed positivity (serology). Moreover cutaneous bacteriology is difficult to assess when other bacteria than streptococci are isolated. Erysipelas have to be distinguished from non-necrotizing cellulitis by peculiar clinical features (such as erysipeloid, facial staphylococcal infection, Pasteurella, Haemophilus influenzae) and from necrotizing fasciitis. Some non-infectious diseases may mimic erysipelas such as venous thrombosis, familial Mediterranean fever, prosthesis intolerance, and compartment syndrome. Because the diagnostic value of clinical symptoms is not known and no diagnostic gold standard has been established, it is impossible to be sure that non-streptococcal erysipelas (especially staphylococcal) really exists. Thus, the first line treatment for all erysipelas must be an antistreptococcal antibiotic. Before prescribing a treatment, hemoculture and blood cell count could be useful. If antistreptococcal antibiotherapy is inefficient, all the differential diagnoses must be reviewed.

Diagnosis, Differential↗
PubMed2005

Erysipelas after breast cancer treatment (26 cases).

Erysipelas is a bacterial hypodermal cellulitis usually associated with Streptococcal infection. Erysipelas of the upper limbs in women treated for breast cancer is relatively rare. We undertook a 10-year retrospective study identifying 26 cases of erysipelas of the upper limb following treatment for breast cancer; we describe the clinical, therapeutic, and evolutionary aspects. The age of our patients ranged from 37 to 80 years with a mean age of 53. All patients had a breast surgery and lymphadenectomy. Fifteen patients had chemotherapy and 23 had radiotherapy. The erysipelas appeared with an average of 5.23 years after cancer treatment (3 months to 15 years) and was recurrent in nine cases. Lymphedema occurred in eighteen patients. The first signs were fever and shivering in 25 patients. The clinical aspect was an inflammatory plaque. The physical findings of erysipelas included a raised edge (6 cases), blisters (1 case), purpura (1 case), and cellulitis (1 case). The portal of entry was not found in eleven patients. The upper limb was affected in all cases. Involvement of the axillary folds or the chest was observed in eight cases. Treatment with penicillin was undertaken for all patients; the length of treatment varied from 11 to 26 days. Lympadenectomy and radiotherapy in breast cancer may lead to lymphedema, which can be evident or sometimes discrete. Those patients who developed erysipelas in our series usually fared well with treatment, but many had recurrences attributed to persistent lymphedema. It was also of note that for many patients in this series, the portal of entry was not identified.

Adult↗
PubMed2006

Oral vaccination against swine erysipelas--field experiences in Croatia.

In order to prove the effects of mass application of oral erysipelas vaccine via drinking water, in a farrow-to-finish production unit in Croatia, the growing-finishing animals were divided into 3 groups and treated as follows:--Group 1 (n=199) was vaccinated intramuscularly against swine erysipelas at 1 week and 3 weeks after arrival in the growing-finishing facility with a swine erysipelas bacterin.--Group 2 (n=199) were vaccinated at the same time with an avirulent culture of Erysipelothrix rhusiopathiae oral vaccine through drinking water.--Group 3 (n=200) was not vaccinated. Animals with clinical signs of swine erysipelas, chronic progressive arthritis at slaughter, mortality, average daily weight gain during the growing-finishing phase were evaluated. None of the pigs in the groups 1 and 2 showed clinical signs typical for acute swine erysipelas. Twenty-four of the pigs (12 %) in group 3 had pyrexia and skin lesions typical for swine erysipelas. Fifteen pigs in group 1, 13 pigs in group 2, and 63 pigs in group 3 had chronic progressive arthritis (group 1 and 2 vs. group 3: P < 0.01). No significant differences in mortality were recorded between the groups. Group 1 and 2 had higher (P < 0.05) average daily weight gains compared with the group 3.

Administration, Oral↗
PubMed1988

[Capacity of mononuclear cells to produce a factor that promotes E-rosette formation in different clinical forms of erysipelas].

The author has examined the capacity of mononuclear cells in peripheral blood samples obtained from erysipelas patients for the in vitro secretion of E-rosette formation promoting factor (E-RPF) in response to polyclonal stimulation with phytohemagglutinin (PHA) P or antigenic stimulation with hemolytic streptococcal allergen. At the acute stage of the disease, mononuclear cells spontaneously secreted E-RPF in a half of the examined patients; at the same time, a statistically significant decrease in the PHA-induced secretion of E-RPF was observed, especially in patients with the primary bullous form and relapses of erysipelas. The optimum lymphokine production in response to PHA in patients with primary erysipelas was observed simultaneously with a low level of spontaneous lymphokine production, while in relapses it was significantly suppressed at all levels of the spontaneous secretion of E-RPF. The antigen-stimulated secretion of E-RPF was observed more frequently in patients with primary bullous erysipelas, while in bullous relapses it was completely absent. At the early stage of convalescence the intensity of the spontaneous secretion of E-RPF decreased, while the PHA-induced secretion of E-RPF enhanced. In relapses the secretion of E-RPF in response to stimulation with the specific allergen remained at a low level, while in convalescents having had primary erysipelas the level of this secretion was high. These data indicate that mononuclear cells in the peripheral blood essentially differ in their capacity to secrete E-RPF in response to polyclonal and antigenic stimulation in various clinical forms of erysipelas.

Acute Disease↗
PubMedDate not supplied

Sodium selenite as prophylaxis against erysipelas in secondary lymphedema.

In a randomised, double-blind study, the efficacy of sodium selenite application in combination with physical therapy to relieve congestion was investigated in a cohort of 60 cancer patients with secondary lymphedema, with special reference to the development of the incidence of erysipelas. All of the patients investigated in this study had erysipelas infection of the skin. Selenium was administered in pharmacological doses. The duration of physical therapy was three weeks. Patients were under observation for a further three months. The incidence of erysipelas among our patients was 11%. During the three-week period of intensive treatment, there was not a single case of erysipelas in the treatment group, whereas there was one single case in the placebo group. In the follow-up period (3 months), once again there was not a single case of erysipelas in the treatment group, but 50% of the patients in the placebo group exhibited erysipelas. In spite of higher doses, the selenium level did not rise above normal values. Patients under long-term antibiotic therapy suffered no relapse when the antibiotic therapy was stopped and instead, selenium was administered. It could be shown, in addition, that by administration of a single high-dose of sodium selenite, inflammation could be immediately brought under control.

Combined Modality Therapy↗
PubMed2000

[Risk factors for local complications in erysipelas].

BACKGROUND AND OBJECTIVE: A complicated course of erysipelas is not uncommon. Bullous, haemorrhagic, necrotic and purulent lesions may be encountered. Today no reliable data exist as to which constitutional factors renders a patient at risk for developing complicated erysipelas though several risk factors, particularly diabetes mellitus, are often suggested. Based on the analysis of patients with erysipelas at the Department of Dermatology in Graz, factors determining the risk for complicated erysipelas should be identified. PATIENTS/METHODS: In a retrospective case-control study clinical data sheets of 766 in- patients treated at the department were evaluated with respect to the course of the erysipelas and with respect to potential risk factors. RESULTS: General risk factors for local complications were location at the lower extremities, pre-existing hepatic or renal disease, hyperuricaemia, and diabetes mellitus. Hepatic and renal disease and - to a lesser extent - diabetes particularly predisposed for bullous and haemorrhagic lesions, while vascular occlusive disease enhanced the risk for necrotic lesions. CONCLUSIONS: Location and hepatic and renal disease are the most important risk factors, while diabetes is probably of less significance than previously suggested.

Adult↗
PubMed1996

[Erysipelas after leg vein harvesting for aortocoronary bypass operation].

We have seen 4 patients in 1995 who showed erysipelas in the leg used for vein graft harvesting for coronary bypass surgery. None of the patients had experienced erysipelas prior to surgery. One patient had his first attack erysipelas while the others experienced recurrent disease. Venectomy puts these patients at risk for later erysipelas. Therefore careful foot hygiene, eradication for mycotic infections and adequate therapy for initial erysipelas are mandatory in cardiac high risk patients after coronary bypass surgery.

Aged↗
PubMed2005

[Management of erysipelas in French hospitals: a post-consensus conference study].

INTRODUCTION: A prospective hospital-based survey on the management of bacterial dermal-hypodermal infections was conducted before the consensus conference "How should Erysipelas-Necrotic Fasciitis be managed?". The results of the survey were circulated early in 2001. To assess the eventual impact of the guidelines from the conference on hospital practices with regard to erysipelas, we conducted a new prospective survey at the end of 2002. PATIENTS AND METHODS: The questionnaire used was identical to that of the 2001 survey. It collected, anonymously, data on the clinical characteristics, supplementary examinations conducted (bacteriology, imaging), initial treatment and outcome. The questionnaire was mailed to the departments of dermatology, internal and/or infectious diseases and intensive care that had replied to the first survey (n = 124). The patients eligible for inclusion were those hospitalized between 09/01/2002 and 11/30/2002. Statistical analysis compared the results with those of the preceding survey. RESULTS: The files of 245 patients were collected that came from 41 departments (15 from university hospitals, 23 from general hospitals and 3 from military hospitals) and 235 of whom had erysipelas. For those with erysipelas, the mean age was of 65 +/- 2.5 years, the M/F sex ratio was of 0.66 and the localization was the leg in 89.5 p. 100 of cases. A Doppler of the legs was performed in 33 p. 100 of cases. The initial antibiotherapy was penicillin G in 38 p. 100 of cases and pristinamycine in 18 p. 100 (others: 44 p. 100). The route of administration was initially intravenous in 73 p. 100 of cases. An anti-coagulant was associated in 60 p. 100. The outcome was favorable in 94 p. 100 of cases, with a mean duration of hospitalization of 11.2 +/- 1.2 days and antibiotics of 17.7 +/- 1.3 days. Dopplers and the blood cultures were performed more frequently than before the consensus conference, but no difference was found in the antibiotics or adjuvant therapies. DISCUSSION: The follow-up survey showed the stability of hospital practices concerning erysipelas, notably with regard to treatment. In contrast, the clear tendency in limiting the supplementary examinations is in agreement with the consensus conference.

Age of Onset↗