To (mostly) no one’s surprise, in descending order:
- Tachypnea at triage
- Chronic skin ulcers
- History of MRSA
- Recurrent cellulitis
- Chronic kidney disease
- Diabetes mellitus
Adjusted ORs for failure topped out at ~6.3, and descend into statistical noise from there.
However, reliably unpacking and generalizing these data is far more challenging, considering the variety of permutations for treatment and treatment failure. Of the initial 500 consecutive non-purulent skin-and-soft-tissue infections enrolled, patients were managed with all manner of combinations of inpatient and outpatient oral and intravenous antibiotics (including 6 patients with both). Treatment failure in the 288 managed primarily as outpatient, as evaluated from 48 hours to 14 days after the initial ED visit, could result in a change of oral agent, change to outpatient intravenous antibiotics, or hospitalization. While the validity of the predictive features of treatment failure is probably not affected by the specifics of their clinical setting, the rate of failure of oral antibiotics – almost 30% – is likely unique to their population and practice pathway.
At least, in contrast to my last cellulitis article, only 3 patients were subsequently judged by an infectious disease specialist to have a misdiagnosis of cellulitis.
“Predictors of Oral Antibiotic Treatment Failure for Non-Purulent Skin and Soft Tissue Infections in the Emergency Department”
https://www.ncbi.nlm.nih.gov/pubmed/29869364