Evolutionary Profile of Cellulitis and Erysipelas of Lower Limbs in a Level-Two Healthcare Facility in Brazzaville, Congo

Abstract

Background: Cellulitis/erysipelas are the most frequent reason for hospitalization in dermatology departments. Objective: To describe evolutionary profile of cellulitis/erysipelas and to determine associated factors with the long hospital stay. Methods: This was a cross-sectional study carried out from January 2016 to December 2018 in Talangai Reference Hospital, that included patients hospitalized for cellulitis or erysipelas of the lower limbs. Necrotizing fasciitis cases were excluded. A hospital stay of more than 11 days was considered long. Sociodemographic, clinical and biological data were collected and processed with Epi Info 7.2.1.0. The Chi-square and Fisher tests were used for univariate analysis. Logistic regression was used for multivariate analysis. Results: One hundred and five patients were included, with an average age of 50.7 (±15) years. They were 26 (24.8%) men and 79 (74.2%) women. Antibiotic regimen used was amoxicillin in 19 (18.1%) cases, amoxicillin / clavulanic acid in 40 (38.1%) cases and ceftriaxone in 46 (43.8%) cases. The outcome was favorable in 69 (65.7%) patients. Fever persisted after 5 days-treatment in 19 (28.3%) patients out of 67 initially. Complications were cutaneous necrosis in 19 (18.0%) cases, abscess in 14 (13.3%) cases, severe sepsis and necrotizing fasciitis in 7 and 4 cases, respectively. Two patients died. The average length of hospital stay was 13 days (±7.5) and 44 (41.9%) cases had a long hospital stay. The bullous forms of cellulitis/erysipelas [aOR=4.8, 95%CI (1.9-12.4); p=0.001] and the occurrence of complications [aOR=3.2, 95%CI (1.1-8.7); p=0.026] were associated with a long hospital stay. Conclusion: Cellulitis and erysipelas are potentially serious. Despite treatment, complications can occur, including necrosis and abscess. Effective management, including early medical treatment, daily thorough monitoring of patients, appropriate local care and collaboration with surgeons, is necessary to improve the prognosis of the disease.