Adherence to antibiotic guidelines for erysipelas or cellulitis is associated with a favorable outcome

  • Camille KlotzEmail author
  • Johan Courjon
  • Céline Michelangeli
  • Elisa Demonchy
  • Raymond Ruimy
  • Pierre-Marie Roger
Original Article


Outside areas of S. aureus strains resistant to methicillin (MRSA) in the community, no studies showed a relationship between the treatment for erysipelas or cellulitis and the outcome. We aimed to measure the impact of an internal therapeutic protocol, based on national guidelines on patients’ outcome. This study was based on the dashboard of the infectious diseases department, which prospectively includes 28 parameters for all admitted patients. We included community-acquired erysipelas and cellulitis; exclusion criteria were abscesses at admission; ear, nose, throat, or dental cellulitis; pyomyositis; and length of stay ≤ 2 days. Adherence to guidelines was defined by the use of amoxicillin, amoxicillin/clavulanic acid, clindamycin, or pristinamycin, alone or in combination or successively. A poor outcome was defined by surgical procedure or intensive care requirement or death occurring after 5 days or more of antibiotic therapy. From July 2005 to June 2017, 630 cases of erysipelas or cellulitis were included. Blood cultures performed in 567 patients (90%) were positive in 39 cases (6.9%). Adherence rate to guidelines was 65% (410 cases). A poor outcome was recorded in 54 (8.5%) patients, less frequently in case of adherence to guidelines: 26/410 (6.3%) vs 28/220 (12.7%), p = 0.007. In logistic regression analysis, two risk factors were associated with a poor outcome: peripheral arterial disease, AOR 4.80 (2.20–10.49); and bacteremia, AOR 5.21 (2.31–11.76), while guideline adherence was the only modifiable protective factor, OR 0.48 (0.26–0.89). In erysipelas and cellulitis, adherence to guidelines was associated with a favorable outcome.


Erysipelas Cellulitis SSTI Antibiotic therapy Guidelines Outcome 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Observational studies do not require ethical approval in France. Antimicrobial stewardship is promoted by the French National Health Agency. Internal dashboard is declared to French Data Protection Authority, number 1430722.

Informed consent

Patients or their relatives provided their written consent for digitization of their personal data for hospitalization purposes.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Camille Klotz
    • 1
    Email author
  • Johan Courjon
    • 1
    • 2
  • Céline Michelangeli
    • 1
  • Elisa Demonchy
    • 1
  • Raymond Ruimy
    • 2
    • 3
  • Pierre-Marie Roger
    • 1
    • 2
    • 4
  1. 1.Infectiologie, Hôpital de l’ArchetCentre Hospitalier Universitaire de NiceNiceFrance
  2. 2.Faculté de MédecineUniversité de Nice Sophia-AntipolisNiceFrance
  3. 3.Bactériologie, Hôpital de l’ArchetCentre Hospitalier Universitaire de NiceNiceFrance
  4. 4.Groupe ElsanParisFrance

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