Changing Inpatient Management of Cellulitis and Cutaneous Abscesses

Patients hospitalized with cellulitis and cutaneous abscesses often undergo unnecessary investigations and receive inappropriately protracted courses of antibiotics with an unnecessarily broad spectrum of activity.

Investigators at a Denver hospital devised management guidelines that recommend more-discriminating use of serum C-reactive protein (CRP), plain radiographs, and blood cultures; and actively discourage use of erythrocyte sedimentation rates, superficial wound cultures, computed tomography (CT), and magnetic resonance imaging (MRI) for these patients. They recommended a specific antibiotic regimen to be given along with a nonsteroidal anti-inflammatory drug (NSAID) for 7 days. They disseminated the guidelines via e-mail, developed an electronic admission order set, and designated attending physicians in five departments (emergency medicine, adult urgent care, internal medicine, general surgery, and orthopedics) to champion the recommendations and to provide information from quarterly audits to their faculty and house staff.

Compared with the 169 patients who were treated for cellulitis or abscess in the year before dissemination of the guidelines, the 175 patients with cellulitis or abscess treated during the year after the guidelines were distributed had significant decreases in the number of blood cultures, use of advanced imaging (CT and MRI), use of wide-spectrum antibiotics, duration of antimicrobial therapy, and number of consultations, especially for general surgery. Significantly more patients received NSAIDs. These differences were not attributable to the electronic order set, which very few clinicians used.