Trakya Üniversitesi Sağlık Araştırma ve Uygulama Merkezi Enfeksiyon Hastalıkları Servisinde izlenen selülit olgularının irdelenmesi ve risk faktörlerinin belirlenmesi
Küçük Resim Yok
Tarih
2011
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Selülit tüm yaş gruplarında görülebilen deri ve derialtı dokuların akutenfeksiyonu olup, önemli morbidite sebeplerinden biridir. İki yıllık dönemi kapsayan bu retrospektif vaka-kontrol çalışmasında, servisimizde izlenen selülit olgularının demografik ve epidemiyolojik özelliklerinin saptanması, selülit gelişimi ve morbidite ile ilişkili risk faktörlerinin ortaya çıkarılması amaçlandı.İki yıllık sürede toplam 44 selülit olgusu irdelendi. Olguların 38'inde alt ekstremite, 5'inde üst ekstremite, 1'inde batın ve tutulumu mevcuttu. Selülit gelişimi ile ilgili olarak tek-değişkenli analiz sonucuna göre; yapılan tek-değişkenli analiz sonucuna göre; kaşıntı, tinea pedis, onikomikoz, periferik damar hastalığı, obezite, lokal travma, safenektomi öyküsü, önceden geçirilmiş selülit hikayesi, diğer cilt hastalıkları istatiksel olarak anlamlı saptandı (p<0.05).Çok-değişkenli analizde sadece lokal travma ve obezite anlamlı risk faktörü olarak belirlendi (p<0.05). Başvuru anında selülite eşlik eden klinik bulgular C-reaktif protein yüksekliği (%84.1), lökositoz (%38.6), ateş yüksekliği (%27.27) ve lenfadenopati (%15.9) olarak bulundu. Olguların yatış (tedavi öncesi) ve çıkış (tedavi sonrası) laboratuar verileri değerlendirildiğinde lökosit, C-reaktif protein, eritrosit sedimentasyon hızı verilerinin ve ekstremiteler arası çap farkının tedavi ile azalması istatistiksel olarak anlamlı saptandı (p<0.05).Etiyolojik tanıya yönelik alınan punch biyopsi ve aspirasyon kültürlerinde %10.8 oranında metisiline duyarlı Staphylococcus aureus üremesi saptandı.Alınan mantar kültürlerinin %47.05'in direk bakısında mantar hif ve elemanı görüldü, %23.52'inde Trichophyton rubrum üremesi oldu. Kan kültürlerinin birinde metisiline duyarlı Staphylococcus aureus ve birinde G grubu streptokok üremesi oldu. Parenteral tedavideolguların %61.36'sında ampisilin-sulbaktam, %36.36'sında sefazolin ve %2.27'sinde klindamisin kullanıldı.Özellikle önceden geçirilmiş selülit hikayesi olanlarda tinea pedis ve onikomikozun tedavi edilmesi, diğer risk faktörlerinin tespiti ve diabetes mellitus gibi altta yatan hastalıkların saptanarak tedavi edilmesi ve hastanın bilgilendirilmesi selülit tekrarını azaltabilir. Uygun tedavi seçenekleri ve süresiyle selülitin klinik seyri yüz güldürücüdür. Ancak predispozan faktörlerin varlığında tekrarlayan selülit atakları ile karşılaşılabileceği unutulmamalıdır.Anahtar kelimeler: Selülit, risk faktörleri, yumuşak doku enfeksiyonu
Cellulitis is the acute infection of skin and connective tissues, observed in all age groups and also is a remarkable reason of morbidity. In this retrospective case-control study of two year period including adult patients, we aimed to identify the demographic and epidemiologic features of patients with cellulitis as well as the related risk factors regarding morbidity.Fortyfour patients with cellulitis were assessed in a two year period. Five of the patients had involvement of upper limbs, while 1 had abdomen and 38 patients had of lower limb involvement. According to the single-variable analysis regarding the development of cellulitis; local trauma, pruritus, onychomycosis, tinea pedis, other skin diseases, peripheral vascular disease, obesity, previous saphenectomy and cellulitis were observed to be statistically significant (p<0.05). Local trauma and obesity were observed to be significant risk factors in the multivariate logistic regression analysis (p<0.05). Clinical findigs accompanying cellulitis at the time of admission were increase in C-reactive protein (84.1%), leucocytosis (38.6%), fever (27.27%), and lymphadenopathy (15.9%). The data at the time of admission (before treatment) and discharge (after treatment) were assessed and the decrease in leucocytosis, C-reactive protein, sedimentation rate and the difference in the diameters of limbs after treatment were observed to be statistically significant (p<0.05).Methicillin sensitive Staphylococcus aureus isolates were obtained from 10.8% of punch biopsy and aspiration samples which were taken for etiological diagnosis. Hyphae and elements of fungi were observed in 47.05% of the samples of fungal culture while Trichophyton rubrum was isolated from 23.52% of the samples. Methicilline sensitive Staphylococcus aureus and group G streptococcus was isolated from one each of the blood culture samples. Ampicillin-sulbactam was used 61.36%, cephazoline 36.36% and clindamycin %2.27 as pareteral theraphy.Treatment of tinea pedis and onychomycosis especially in patients with previous cellulitis, determination of other risk factors or comorbidities such as dibetes mellitus, their appropriate treatment and informing the patient may decrease the recurrence of cellulitis. Clinical course of cellulitis is gratifying with the appropriate treatment alternatives and duration. Nevertheless, it should be kept in mind that with a predisposing factor, recurrent episodes of cellulitis may be encountered.Key words: Cellulitis, risk factors, soft tissue infection
Cellulitis is the acute infection of skin and connective tissues, observed in all age groups and also is a remarkable reason of morbidity. In this retrospective case-control study of two year period including adult patients, we aimed to identify the demographic and epidemiologic features of patients with cellulitis as well as the related risk factors regarding morbidity.Fortyfour patients with cellulitis were assessed in a two year period. Five of the patients had involvement of upper limbs, while 1 had abdomen and 38 patients had of lower limb involvement. According to the single-variable analysis regarding the development of cellulitis; local trauma, pruritus, onychomycosis, tinea pedis, other skin diseases, peripheral vascular disease, obesity, previous saphenectomy and cellulitis were observed to be statistically significant (p<0.05). Local trauma and obesity were observed to be significant risk factors in the multivariate logistic regression analysis (p<0.05). Clinical findigs accompanying cellulitis at the time of admission were increase in C-reactive protein (84.1%), leucocytosis (38.6%), fever (27.27%), and lymphadenopathy (15.9%). The data at the time of admission (before treatment) and discharge (after treatment) were assessed and the decrease in leucocytosis, C-reactive protein, sedimentation rate and the difference in the diameters of limbs after treatment were observed to be statistically significant (p<0.05).Methicillin sensitive Staphylococcus aureus isolates were obtained from 10.8% of punch biopsy and aspiration samples which were taken for etiological diagnosis. Hyphae and elements of fungi were observed in 47.05% of the samples of fungal culture while Trichophyton rubrum was isolated from 23.52% of the samples. Methicilline sensitive Staphylococcus aureus and group G streptococcus was isolated from one each of the blood culture samples. Ampicillin-sulbactam was used 61.36%, cephazoline 36.36% and clindamycin %2.27 as pareteral theraphy.Treatment of tinea pedis and onychomycosis especially in patients with previous cellulitis, determination of other risk factors or comorbidities such as dibetes mellitus, their appropriate treatment and informing the patient may decrease the recurrence of cellulitis. Clinical course of cellulitis is gratifying with the appropriate treatment alternatives and duration. Nevertheless, it should be kept in mind that with a predisposing factor, recurrent episodes of cellulitis may be encountered.Key words: Cellulitis, risk factors, soft tissue infection
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları, Clinical Microbiology and Infectious Diseases
