Clinical features, microbiological epidemiology and recommendations for management of cellulitis in extremity lymphedema

• Published in: Journal of surgical oncology 2020-01, Vol.121 (1), p.25-36
• Main Authors: Rodriguez, Jose R., Hsieh, Frank, Huang, Ching‐Tai, Tsai, Tai‐Jung, Chen, Courtney, Cheng, Ming‐Huei
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Antibiotics; Bacterial Infections - drug therapy; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Bacterial Infections - pathology; cellulitis; Cellulitis - drug therapy; Cellulitis - epidemiology; Cellulitis - microbiology; Cellulitis - pathology; Cohort Studies; Epidemiology; Extremities - microbiology; Extremities - pathology; Female; Humans; lymphatic diseases; Lymphedema; Lymphedema - epidemiology; Lymphedema - microbiology; Lymphedema - pathology; Male; Middle Aged; Prevalence; Retrospective Studies; streptococcal infections
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25525

Background This high volume, single center study investigated the prevalence, bacterial epidemiology, and responsiveness to antibiotic therapy of cellulitis in extremity lymphedema. Methods From 2003 to 2018, cellulitis events from a cohort of 420 patients with extremity lymphedema were reviewed. Demographics, lymphedema grading, symptoms, inflammatory markers, cultures and antibiotic therapy regimens were compiled from cellulitis episodes data. Univariate and multivariate analyses were performed for detailed analysis. Results A total of 131 separate episodes of cellulitis were recorded from 43 (81.1%) lower limb and 10 (19.9%) upper limb lymphedema patients. The prevalence and recurrence rates for cellulitis in lymphedema patients were 12.6% (53 of 420) and 56.6% (30 of 53), respectively. The most common findings were increased limb circumference (127 of 131; 96.9%) and abnormal C‐reactive protein (CRP) level (86 of 113; 76.1%). Blood cultures were obtained in 79 (60.3%) incidents, with 9 (11.4%) returning positive. Streptococcus agalactiae was the most isolated bacterium (5 of 9; 55.5%). Conclusions The cellulitis prevalence and recurrence rate in extremity lymphedema were 12.6%, and 56.6%, respectively. Strongest indicators of cellulitis were increased affected limb circumference and elevated CRP level. Empiric antibiotic therapy began with coverage for Steptococcus species before broadening to anti‐Methicillin‐resistant Staphylococcus aureus and anti‐Gram negatives if needed for effective treatment of extremity lymphedema cellulitis.