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1.
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Wozniak TM, Cuningham W, Buchanan S, Coulter S, Baird RW, Nimmo GR, Blyth CC, Tong SYC, Currie BJ, Ralph AP, 2020. Geospatial epidemiology of Staphylococcus aureus in a tropical setting: An enabling digital surveillance platform. Sci Rep 10: 13169.
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Guan G, Lee CMY, Begg S, Crombie A, Mnatzaganian G, 2022. The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: A systematic review and meta-analysis. PLoS One 17: e0265559.
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Microbiological and Clinical Features of Patients with Cellulitis in Tropical Australia: Disease Severity Assessment and Implications for Clinical Management
Rory Townend
Rory Townend
Department of Medicine, Cairns Hospital, Cairns, Australia;
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Simon Smith
Simon Smith
Department of Medicine, Cairns Hospital, Cairns, Australia;
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Josh Hanson
jhanson@kirby.unsw.edu.au
Josh Hanson
Department of Medicine, Cairns Hospital, Cairns, Australia;
Kirby Institute, University of New South Wales, Sydney, Australia
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Kirby Institute, University of New South Wales, Sydney, Australia
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ABSTRACT.
Australian guidelines for the treatment of cellulitis are informed by data from temperate, metropolitan centers. It is uncertain if these guidelines are equally applicable in tropical Australia, where the population, access to healthcare, and array of potential pathogens are quite different. This retrospective study examined adults admitted to Cairns Hospital in tropical Queensland, Australia, who were treated with intravenous antibiotics for a principal diagnosis of cellulitis in 2019. The study aimed to describe the epidemiological, clinical, and microbiological findings in these cases and the resulting implications for patient management. There were 305 episodes of cellulitis; a potential pathogen was identified in 93/305 (30%), most commonly Staphylococcus aureus (45/93, 48%) or Group A Streptococcus (16/93, 17%). There was one case of Burkholderia pseudomallei. Initial treatment was most commonly with narrow spectrum β-lactam antibiotics with flucloxacillin prescribed in 170/305 (56%) and cefazolin prescribed in 74/305 (26%). Overall, 4/305 (1%) died or were admitted to the intensive care unit (ICU) within 30 days, 123/305 (40%) had an inpatient stay >48 hours, and 63/305 (21%) were readmitted to hospital within 30 days. Every patient who subsequently died or required ICU admission had an elevated early warning score (EWS ≥3) on admission. An EWS ≥3 on admission also predicted an inpatient stay of >48 hours (odds ratio [OR]: 3.2, 95% CI: 1.7–6.0; P <0.001) and 30-day readmission (OR: 2.3, 95% CI: 1.2–4.6; P = 0.01). The etiology of cellulitis in tropical Queensland, Australia, is very similar to that seen in temperate regions, enabling the use of standard management algorithms for patients with cellulitis in the region.
- Supplemental Materials (PDF 120.85 KB)
Author Notes
Disclosures: The FNQ Human Research Ethics Committee provided ethical approval for the study (Reference EX/2022/QCH/87434 – 1620 QA). Because the data were retrospective and de-identified, the Committee waived the requirement for informed consent.
Current contact information: Rory Townend and Simon Smith, Department of Medicine, Cairns Hospital, Cairns, Australia, E-mails: rory.townend@health.qld.gov.au and simon.smith2@health.qld.gov.au. Josh Hanson, Department of Medicine, Cairns Hospital, Cairns, Australia, and The Kirby Institute, University of New South Wales, Sydney, Australia, E-mail: jhanson@kirby.unsw.edu.au.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Australian Institute of Health and Welfare, 2018. Emergency Department Care 2017–18: Australian Hospital Statistics. Canberra, Australia: Australian Institute of Health and Welfare.
-
2.
Webb E, Bissett B, Neeman T, Bowden F, Preston E, Mumford V, 2023. Compression therapy is cost-saving in the prevention of lower limb recurrent cellulitis in patients with chronic edema. Lymphat Res Biol 21: 160–168.
-
3.
Australian Commission on Safety and Quality in Healthcare, 2021. The Fourth Australian Atlas of Healthcare Variation Australian Commission on Safety and Quality in Health Care. Canberra, Australia: Australian Commission on Safety and Quality in Healthcare. Available at: https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/chronic-disease-and-infection-potentially-preventable-hospitalisations/25-cellulitis-hospitalisations. Accessed November 24, 2023.
-
4.
Therapeutic Guidelines, 2021. Cellulitis and Erysipelas. Available at: https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Antibiotic&topicfile=cellulitis-erysipelas. Accessed December 1, 2023.
-
5.
Davis JS, Cheng AC, McMillan M, Humphrey AB, Stephens DP, Anstey NM, 2011. Sepsis in the tropical Top End of Australia’s Northern Territory: Disease burden and impact on Indigenous Australians. Med J Aust 194: 519–524.
-
6.
Hanson J, Smith S, Brooks J, Groch T, Sivalingam S, Curnow V, Carter A, Hargovan S, 2020. The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: An observational study. PLoS One 15: e0236339.
-
7.
Fox H, Hempenstall A, Pilot P, Callander E, Smith S, McDonald MI, Hanson J, 2024. Significant healthcare resource utilisation in the management of skin and soft tissue infections in the Torres Strait, Australia. Rural Remote Health 24: 8572.
-
8.
Rathnayake D, Sinclair R, 2014. Tropical and exotic dermatoses and ulcers. Aust Fam Physician 43: 604–609.
-
9.
Currie BJ et al., 2021. The Darwin Prospective Melioidosis Study: A 30-year prospective, observational investigation. Lancet Infect Dis 21: 1737–1746.
-
10.
Smith S et al., 2023. Clinical manifestations and genomic evaluation of melioidosis outbreak among children after sporting event, Australia. Emerg Infect Dis 29: 2218–2228.
-
11.
Robinson DC, Adriaans B, Hay RJ, Yesudian P, 1988. The clinical and epidemiologic features of tropical ulcer (tropical phagedenic ulcer). Int J Dermatol 27: 49–53.
-
12.
Steffen CM, Freeborn H, 2018. Mycobacterium ulcerans in the Daintree 2009–2015 and the mini-epidemic of 2011. ANZ J Surg 88: E289–E293.
-
13.
Hempenstall A, Smith S, Hanson J, 2019. Leprosy in Far North Queensland: Almost gone, but not to be forgotten. Med J Aust 211: 182–183.
-
14.
Sim BZ, Conway L, Smith LK, Fairhead L, Der YS, Payne L, Binotto E, Smith S, Hanson J, 2022. The aetiology and clinical characteristics of cryptococcal infections in Far North Queensland, tropical Australia. PLoS One 17: e0265739.
-
15.
Hempenstall A, Pilot P, McDonald M, Smith S, Hanson J, 2023. Community antibiotic management of skin infections in the Torres Strait. Aust J Prim Health 29: 91–98.
-
16.
Davidson N, Edwards F, Harris PNA, Laupland KB, 2023. Vibrio species bloodstream infections in Queensland, Australia. Intern Med J 54: 157–163.
-
17.
Sinclair HA, Edwards F, Harris PNA, Heney C, Laupland KB, 2022. Epidemiology of Aeromonas species bloodstream infection in Queensland, Australia: Association with regional and climate zones. Microorganisms 11: 36.
-
18.
Guthridge I, Smith S, Horne P, Hanson J, 2019. Increasing prevalence of methicillin-resistant Staphylococcus aureus in remote Australian communities: Implications for patients and clinicians. Pathology 51: 428–431.
-
19.
Wozniak TM, Cuningham W, Buchanan S, Coulter S, Baird RW, Nimmo GR, Blyth CC, Tong SYC, Currie BJ, Ralph AP, 2020. Geospatial epidemiology of Staphylococcus aureus in a tropical setting: An enabling digital surveillance platform. Sci Rep 10: 13169.
-
20.
Coombs GW, Daley DA, Shoby P, Mowlaboccus S, 2023. Australian Group on Antimicrobial Resistance (AGAR) Australian Staphylococcus aureus Surveillance Outcome Program (ASSOP) Bloodstream Infection Annual Report 2022. Commun Dis Intell (2018) 47. Available at: https://pubmed.ncbi.nlm.nih.gov/37968066/. Accessed October 21, 2024.
-
21.
Australian Institute of Health and Welfare, 2018. Survey of Health Care: Selected Findings for Rural and Remote Australians. Canberra, Australia: Australian Institute of Health and Welfare.
-
22.
Ohnuma T, Chihara S, Costin B, Treggiari MM, Bartz RR, Raghunathan K, Krishnamoorthy V, 2023. Association of appropriate empirical antimicrobial therapy with in-hospital mortality in patients with bloodstream infections in the US. JAMA Netw Open 6: e2249353.
-
23.
Marwick C, Broomhall J, McCowan C, Phillips G, Gonzalez-McQuire S, Akhras K, Merchant S, Nathwani D, Davey P, 2011. Severity assessment of skin and soft tissue infections: Cohort study of management and outcomes for hospitalized patients. J Antimicrob Chemother 66: 387–397.
-
24.
Cutfield T, Walter H, Hobbs M, Chuang A, Thomas MG, Ritchie SR, 2019. Association of the Dundee severity classification with mortality, length of stay and readmission in adult inpatients with cellulitis. J Antimicrob Chemother 74: 200–206.
-
25.
Ritchie SR, Cutfield T, Lee A, Walter H, Gow R, Gammie T, Punnoose C, Nagarkar S, Thomas MG, 2021. The impact of the Auckland cellulitis pathway on length of hospital stay, mortality readmission rate, and antibiotic stewardship. Clin Infect Dis 73: 859–865.
-
26.
Guan G, Lee CMY, Begg S, Crombie A, Mnatzaganian G, 2022. The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: A systematic review and meta-analysis. PLoS One 17: e0265559.
-
27.
Mar Minn M et al., 2021. The comparative ability of commonly used disease severity scores to predict death or a requirement for ICU care in patients hospitalised with possible sepsis in Yangon, Myanmar. Int J Infect Dis 104: 543–550.
-
28.
van Rooijen CR, de Ruijter W, van Dam B, 2013. Evaluation of the threshold value for the Early Warning Score on general wards. Neth J Med 71: 38–43.
-
29.
Redfern OC, Smith GB, Prytherch DR, Meredith P, Inada-Kim M, Schmidt PE, 2018. A comparison of the Quick Sequential (Sepsis-Related) Organ Failure Assessment Score and the National Early Warning Score in non-ICU patients with/without infection. Crit Care Med 46: 1923–1933.
-
30.
Australian Bureau of Statistics, 2021. Australia: 2021 Census All Persons QuickStats. Available at: https://www.abs.gov.au/census/find-census-data/quickstats/2021/AUS. Accessed November 30, 2023.
-
31.
Riddell J et al., 2023. The high burden of comorbidities in Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in Far North Queensland, Australia, and the implications for patient management. PLoS One 18: e0284151.
-
32.
Australian Bureau of Statistics, 2021. Socio-Economic Indexes for Areas (SEIFA), Australia. Canberra, Australia: Australian Bureau of Statistics.
-
33.
Kang K, Chau KWT, Howell E, Anderson M, Smith S, Davis TJ, Starmer G, Hanson J, 2021. The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997–2017; Impact of socioeconomic status on disease burden, severity and access to care. PLoS Negl Trop Dis 15: e0008990.
-
34.
Hanson J, Smith S, Stewart J, Horne P, Ramsamy N, 2021. Melioidosis – A disease of socioeconomic disadvantage. PLoS Negl Trop Dis 15: e0009544.
-
35.
Nguyen ADK, Smith S, Davis TJ, Yarwood T, Hanson J, 2023. The efficacy and safety of a shortened duration of antimicrobial therapy for group A Streptococcus bacteremia. Int J Infect Dis 128: 11–19.
-
36.
Young A, Smith S, Horne P, Thomsett B, Hanson J, 2018. Chromobacterium violaceum in Northern Australia: A sheep in wolf’s clothing? Am J Trop Med Hyg 99: 844–848.
-
37.
Sim BZ et al., 2023. A multi-centre retrospective study of Nocardia speciation and antimicrobial susceptibility in Queensland, Australia. Eur J Clin Microbiol Infect Dis 42: 339–345.
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