Risk factors of cellulitis in cirrhosis and antibiotic prophylaxis in preventing recurrence

Rooby Hamza Erachamveettil; Mashhood Padincharepurathu Villyoth; George Peter; Deni Joseph; Chethan Govindaraju; Devang Chandrakanth Tank; Sreejaya Sreesh; Premalatha Narayanan; Kattoor Ramakrishnan Vinayakumar

Authors Rooby Hamza Erachamveettil, Mashhood Padincharepurathu Villyoth, George Peter, Deni Joseph, Chethan Govindaraju, Devang Chandrakanth Tank, Sreejaya Sreesh, Premalatha Narayanan, Kattoor Ramakrishnan Vinayakumar.

Abstract

Background Cellulitis is a commonly encountered bacterial infection among cirrhotic patients apart from spontaneous bacterial peritonitis, urinary tract and respiratory infections. This study aimed to determine the risk factors of cellulitis in cirrhosis and whether antibiotic prophylaxis helps prevent recurrence of cellulitis.

Methods The study was conducted in two phases. In phase 1, all cirrhotic patients admitted with cellulitis from August 2011 to August 2013 were taken as cases (n=70) and cirrhotic patients without cellulitis were included as controls (n=73). Baseline demographic data, comorbidities and investigations were noted and compared. In phase 2, the cases of phase 1 were divided into two groups, based on initiation of antibiotic prophylaxis at the time of discharge and were followed up for six months for recurrence of cellulitis.

Results The main etiology of cirrhosis was alcohol and 68% of cases were Child C. Factors which showed signifi cance in univariate analysis were presence of diabetes mellitus, hepatic encephalopathy, platelet count, albumin level and model for end-stage liver disease (MELD) score. Using logistic regression, hepatic encephalopathy (OR 2.95, CI 1.01-8.45), albumin level <2.5 g/dL (OR 2.80, CI 1.32-5.92) and MELD >15 (OR 2.95, CI 1.39-6.27) emerged as significant factors associated with cellulitis. Cellulitis recurred in 20% and recurrence was significantly low among antibiotic prophylaxis group (15% vs. 50% P=0.048).

Conclusions Hypoalbuminemia, and high MELD score are the risk factors for cellulitis in cirrhosis. Antibiotic prophylaxis can reduce the recurrence of cellulitis as in the case of spontaneous bacterial peritonitis.

Keywords Cellulitis, cirrhosis, risk factors, recurrence, antibiotic prophylaxis

Ann Gastroenterol 2014; 27 (4): 374-379