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The Impact of the Auckland Cellulitis Pathway on Length of Hospital Stay, Mortality Readmission Rate, and Antibiotic Stewardship.
Ritchie, Stephen R; Cutfield, Tim; Lee, Arier; Walter, Hannah; Gow, Robert; Gammie, Todd; Punnoose, Christy; Nagarkar, Suyog; Thomas, Mark G.
Afiliação
  • Ritchie SR; Department of Infectious Diseases, Auckland District Health Board, Auckland, New Zealand.
  • Cutfield T; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
  • Lee A; Department of Infectious Diseases, Auckland District Health Board, Auckland, New Zealand.
  • Walter H; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
  • Gow R; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
  • Gammie T; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
  • Punnoose C; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
  • Nagarkar S; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
  • Thomas MG; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Clin Infect Dis ; 73(5): 859-865, 2021 09 07.
Article em En | MEDLINE | ID: mdl-33639623
ABSTRACT

BACKGROUND:

The Dundee classification of cellulitis severity, previously shown to predict disease outcomes, provides an opportunity to improve the management of patients with cellulitis.

METHODS:

We developed and implemented a pathway to guide the management of adults with cellulitis based on their Dundee severity class, and measured its effect on patient outcomes. We compared the outcomes in patients admitted to Auckland City Hospital (ACH) between July 2014 and July 2015 (the baseline cohort) with those in patients admitted between June 2017 and June 2018 (the intervention cohort).

RESULTS:

The median length of stay was shorter in the intervention cohort (0.7 days, interquartile range (IQR) 0.1 to 3.0 days) than in the baseline cohort (1.8 days, IQR 0.1 to 4.4 days; P < .001). The 30-day mortality rate declined from 1.8% (19/1092) in the baseline cohort to 0.7% (10/1362; P = .02) in the intervention cohort. The 30-day cellulitis readmission rate increased from 6% in the baseline cohort to 11% (P < .001) in the intervention cohort. Adherence to the ACH cellulitis antibiotic guideline improved from 38% to 48% (P < .01) and was independently associated with reduced length of stay.

CONCLUSIONS:

The implementation of the Auckland cellulitis pathway, readily generalizable to other settings, improved the outcomes in patients with cellulitis, and resulted in an annual saving of approximately 1000 bed days.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Celulite (Flegmão) / Gestão de Antimicrobianos Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Revista: Clin Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Nova Zelândia

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Celulite (Flegmão) / Gestão de Antimicrobianos Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Revista: Clin Infect Dis Assunto da revista: DOENCAS TRANSMISSIVEIS Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Nova Zelândia