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Master Thesis

Étude d’impact d’un protocole d’antibiothérapie dans les infections cutanées communautaires

Abstract : Purpose : Outside areas of S. aureus strains resistant to methicillin (MRSA) in the community, no studies showed a relationship between the treatment for erysipelas or cellulitis and the outcome. We aimed to measure the impact of an internal therapeutic protocol, based on national guidelines on patients’ outcome.
Methods : This study was based on the dashboard of the infectious diseases department, which prospectively includes 28 parameters for all admitted patients. We included community acquired erysipelas and cellulitis; exclusion criteria were abscesses at admission, ear nose throat or dental cellulitis, pyomyositis and length of stay ≤ 2 days. Adherence to guidelines was defined by the use of amoxicillin, amoxicillin/clavulanic acid, clindamycin or pristinamycin, alone or in combination or successively. A poor outcome was defined by surgical procedure or intensive care requirement or death occurring after 5 days or more of antibiotic therapy.
Results : From July 2005 to June 2017, 630 cases of erysipelas or cellulitis were included. Blood cultures performed in 567 patients (90%) were positive in 39 cases (6.9%). Adherence rate to guidelines was 65% (410 cases). A poor outcome was recorded in 54 (8.5%) patients, less frequently in case of adherence to guidelines: 26/410 (6.3%) vs 28/220 (12.7%), p = 0.007. In logistic regression analysis, 2 risk factors were associated with a poor outcome: peripheral arterial disease: AOR 4.80 [2.20 – 10.49] and bacteraemia: AOR 5.21 [2.31 - 11.76], while guideline adherence was the only modifiable protective factor: OR 0.48 [0.26 - 0.89].
Conclusion : In erysipelas and cellulitis, adherence to guidelines was associated with a favourable outcome.
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Master Thesis
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Camille Klotz. Étude d’impact d’un protocole d’antibiothérapie dans les infections cutanées communautaires. Médecine humaine et pathologie. 2019. ⟨dumas-02381364⟩

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