Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of Dundee and ALT-70 predictive models for cellulitis in 56 patients who underwent tissue culture

  • Short Report
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Nonpurulent cellulitis lacks a gold standard to distinguish noninfectious sources of inflammation. Two models have been created that evaluate cellulitis. The ALT-70 model was created to reduce the overdiagnosis of cellulitis and provide clinical direction. The Dundee classification was developed to grade the severity of previously diagnosed cases of cellulitis and enhance treatment and clinical outcomes. We analyzed a dataset of 56 patients who were admitted to the OSU Wexner Medical Center with a primary admission diagnosis of cellulitis. Each patient underwent extensive tissue culture sampling to identify potential pathogens. Patients were scored using both models, then evaluated based on the positive tissue culture and skin and soft tissue infection. In both models, we found low sensitivity and specificity to predict patients with positive tissue culture cellulitis. Determination of a gold standard for classification of cellulites is important to improve future diagnosis and risk models. We recommend further study to develop a scalable consensus standard in the diagnosis of nonpurulent cellulitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zhang M, Markova A, Harp J, Dusza S, Rosenbach M, Kaffenberger BH (2019) Dermatology-specific and all-cause 30-day and calendar-year readmissions and costs for dermatologic diseases from 2010 to 2014. J Am Acad Dermatol 81(3):740–748. https://doi.org/10.1016/j.jaad.2019.05.023

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gupta P, Tolliver S, Zhang M, Schumacher E, Kaffenberger BH (2020) Impact of dermatology and teledermatology consultations for patients admitted with cellulitis: a pilot study. J Am Acad Dermatol 82(2):513–515. https://doi.org/10.1016/j.jaad.2019.09.022

    Article  PubMed  Google Scholar 

  3. Raff AB, Weng QY, Cohen JM et al (2017) A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study. J Am Acad Dermatol. 76(4):618-625.e2. https://doi.org/10.1016/j.jaad.2016.12.044

    Article  PubMed  Google Scholar 

  4. Marwick C, Broomhall J, McCowan C et al (2011) Severity assessment of skin and soft tissue infections: cohort study of management and outcomes for hospitalized patients. J Antimicrob Chemother 66(2):387–397. https://doi.org/10.1093/jac/dkq362

    Article  CAS  PubMed  Google Scholar 

  5. Johnson KE, Kiyatkin DE, An AT, Riedel S, Melendez J, Zenilman JM (2012) PCR offers no advantage over culture for microbiologic diagnosis in cellulitis. Infection. 40(5):537–541. https://doi.org/10.1007/s15010-012-0289-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Christensen KLY, Holman RC, Steiner CA, Sejvar JJ, Stoll BJ, Schonberger LB (2009) Infectious disease hospitalizations in the United States. Clin Infect Dis 49(7):1025–1035. https://doi.org/10.1086/605562

    Article  PubMed  Google Scholar 

  7. Levell NJ, Wingfield CG, Garioch JJ (2011) Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol 164(6):1326–1328. https://doi.org/10.1111/j.1365-2133.2011.10275.x

    Article  CAS  PubMed  Google Scholar 

  8. Kilburn SA, Featherstone P, Higgins B et al (2010) Interventions for cellulitis and erysipelas. Cochrane Database Syst Rev (6):CD004299.9. https://doi.org/10.1002/14651858.CD004299.pu. https://doi.org/10.1002/14651858.cd004299.pub2

  9. Johnson K, Kiyatkin D, An A et al (2012) PCR offers no advantage over culture for microbiologic diagnosis in cellulitis. Infection 40(5):537–541. https://doi.org/10.1038/jid.2014.371

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Pallin DJ, Bry L, Dwyer RC et al (2016) Toward an objective diagnostic test for bacterial cellulitis. PLoS One 11(9):1–15. https://doi.org/10.1371/journal.pone.0162947

    Article  CAS  Google Scholar 

Download references

Funding

This publication [or project] was supported, in part, by the National Center for Advancing Translational Sciences of the National Institutes of Health under Grant Number UL1TR002733. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.”

Author information

Authors and Affiliations

  1. College of Medicine, The Ohio State University, Columbus, OH, USA

    Trent D. Walker & Ty W. Gilkey

  2. Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA

    John Christopher Trinidad, Catherine G. Chung, Henry Wang & Benjamin H. Kaffenberger

  3. Department of Pathology and Laboratory Medicine, The Ohio State University, Columbus, OH, USA

    Catherine G. Chung

  4. Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Arash Mostaghimi

  5. 1328 Dublin Road, Suite 100, Columbus, OH, 43212, USA

    Benjamin H. Kaffenberger

Authors
  1. Trent D. Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ty W. Gilkey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Christopher Trinidad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catherine G. Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henry Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arash Mostaghimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Benjamin H. Kaffenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TW and TG performed the data collection and statistical analysis. JCT, CC, HW and BK collected primary data. TW and BK wrote the manuscript and prepared the tables. All authors reviewed the manuscript.

Corresponding author

Correspondence to Benjamin H. Kaffenberger.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Walker, T.D., Gilkey, T.W., Trinidad, J.C. et al. Evaluation of Dundee and ALT-70 predictive models for cellulitis in 56 patients who underwent tissue culture. Arch Dermatol Res 315, 665–668 (2023). https://doi.org/10.1007/s00403-022-02409-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-022-02409-0

Keywords

Search

Navigation