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

Jose R. Rodriguez, Frank Hsieh, Ching Tai Huang, Tai Jung Tsai, Courtney Chen, Ming Huei Cheng*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

15 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)25-36
Number of pages12
JournalJournal of Surgical Oncology
Volume121
Issue number1
DOIs
StatePublished - 01 01 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 Wiley Periodicals, Inc.

Keywords

  • cellulitis
  • lymphatic diseases
  • lymphedema
  • streptococcal infections

Fingerprint

Dive into the research topics of 'Clinical features, microbiological epidemiology and recommendations for management of cellulitis in extremity lymphedema'. Together they form a unique fingerprint.

Cite this