Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study
Identifieur interne : 000C63 ( Pmc/Curation ); précédent : 000C62; suivant : 000C64Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study
Auteurs : Tsi Njim [Cameroun] ; Leopold Ndemnge Aminde [Australie] ; Valirie Ndip Agbor [Cameroun] ; Louise Daniele Toukam [Cameroun] ; Sara Saheb Kashaf ; Eric O. OhumaSource :
- BMC Infectious Diseases [ 1471-2334 ] ; 2017.
Abstract
Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventive strategies in Cameroon.
This was a hospital–based case-control study carried out in the Bamenda Regional Hospital (BRH) between September 2015 and August 2016. Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature ≥ 38 °C) and/or chills of sudden onset. Controls were adults hospitalised for diseases other than cellulitis, necrotising fasciitis, myositis, abscess or other variants of dermo-hypodermitis. Cases and controls were matched (1:2) for age and sex.
Of the 183 participants (61 cases of cellulitis and 122 controls) included in the study, the median age was 52 years [Interquartile range (IQR): 32.5–74.5]. After controlling for potential confounders, obesity [adjusted odds ratio (AOR) = 4.7, 95% CI (1.5–14.7);
This study showed a high disease burden among patients with cellulitis. While risk factors identified are similar to prior literature, this study provides a contextual evidence-base for clinicians in this region to be more aggressive in management of these risk factors to prevent disease progression and development of cellulitis.
Url:
DOI: 10.1186/s12879-017-2519-1
PubMed: 28606058
PubMed Central: 5469018
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventive strategies in Cameroon.</p>
</sec>
<sec><title>Methods</title>
<p>This was a hospital–based case-control study carried out in the Bamenda Regional Hospital (BRH) between September 2015 and August 2016. Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature ≥ 38 °C) and/or chills of sudden onset. Controls were adults hospitalised for diseases other than cellulitis, necrotising fasciitis, myositis, abscess or other variants of dermo-hypodermitis. Cases and controls were matched (1:2) for age and sex.</p>
</sec>
<sec><title>Results</title>
<p>Of the 183 participants (61 cases of cellulitis and 122 controls) included in the study, the median age was 52 years [Interquartile range (IQR): 32.5–74.5]. After controlling for potential confounders, obesity [adjusted odds ratio (AOR) = 4.7, 95% CI (1.5–14.7); <italic>p</italic>
= 0.009], history of skin disruption [AOR = 12.4 (3.9–39.1); <italic>p</italic>
< 0.001], and presence of toe-web intertrigo [AOR = 51.4 (11.7–225.6); <italic>p</italic>
< 0.001] were significantly associated with cellulitis. Median hospital stay was longer (14 days [IQR: 6–28]) in cases compared to the controls (3 days [IQR: 2–7]). Among the cases, Streptococci species were the most frequent (<italic>n</italic>
= 50, 82%) isolated germ followed by staphylococci species (<italic>n</italic>
= 9, 15%). Patients with cellulitis were more likely to undergo necrosectomy (OR: 21.2; 95% CI: 7.6–59.2). Toe-web intertrigo had the highest (48.9%) population attributable risk for cellulitis, followed by history of disruption of skin barrier (37.8%) and obesity (20.6%).</p>
</sec>
<sec><title>Conclusion</title>
<p>This study showed a high disease burden among patients with cellulitis. While risk factors identified are similar to prior literature, this study provides a contextual evidence-base for clinicians in this region to be more aggressive in management of these risk factors to prevent disease progression and development of cellulitis.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Infect. Dis</journal-id>
<journal-title-group><journal-title>BMC Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="epub">1471-2334</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">28606058</article-id>
<article-id pub-id-type="pmc">5469018</article-id>
<article-id pub-id-type="publisher-id">2519</article-id>
<article-id pub-id-type="doi">10.1186/s12879-017-2519-1</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Njim</surname>
<given-names>Tsi</given-names>
</name>
<address><email>tsinjim@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Aminde</surname>
<given-names>Leopold Ndemnge</given-names>
</name>
<address><email>amindeln@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff3">3</xref>
<xref ref-type="aff" rid="Aff4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Agbor</surname>
<given-names>Valirie Ndip</given-names>
</name>
<address><email>nvagbor@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Toukam</surname>
<given-names>Louise Daniele</given-names>
</name>
<address><email>louise.toukam@yahoo.com</email>
</address>
<xref ref-type="aff" rid="Aff6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kashaf</surname>
<given-names>Sara Saheb</given-names>
</name>
<address><email>sara.sahebkashaf@stcatz.ox.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ohuma</surname>
<given-names>Eric O.</given-names>
</name>
<address><email>eric.ohuma@csm.ox.ac.uk</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff7">7</xref>
</contrib>
<aff id="Aff1"><label>1</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8948</institution-id>
<institution-id institution-id-type="GRID">grid.4991.5</institution-id>
<institution>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Old Road Campus,</institution>
<institution>University of Oxford,</institution>
</institution-wrap>
Oxford, OX3 7BN UK</aff>
<aff id="Aff2"><label>2</label>
Health and Human Development Research Group, Douala, Cameroon</aff>
<aff id="Aff3"><label>3</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0000 9320 7537</institution-id>
<institution-id institution-id-type="GRID">grid.1003.2</institution-id>
<institution>School of Public Health, Faculty of Medicine,</institution>
<institution>University of Queensland,</institution>
</institution-wrap>
Brisbane, Australia</aff>
<aff id="Aff4"><label>4</label>
Clinical Research Education, Networking and Consultancy (CRENC), Douala, Littoral Cameroon</aff>
<aff id="Aff5"><label>5</label>
Ibal sub – Divisional Hospital, Oku, Northwest Region, Oku, Cameroon</aff>
<aff id="Aff6"><label>6</label>
<institution-wrap><institution-id institution-id-type="GRID">grid.449799.e</institution-id>
<institution>Faculty of Health Sciences,</institution>
<institution>University of Bamenda,</institution>
</institution-wrap>
Bamenda, Northwest Region, Cameroon</aff>
<aff id="Aff7"><label>7</label>
<institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1936 8948</institution-id>
<institution-id institution-id-type="GRID">grid.4991.5</institution-id>
<institution>Centre for Statistics in Medicine, Botnar Research Centre,</institution>
<institution>Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford,</institution>
</institution-wrap>
Windmill Road, Oxford, OX3 7LD UK</aff>
</contrib-group>
<pub-date pub-type="epub"><day>12</day>
<month>6</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>12</day>
<month>6</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection"><year>2017</year>
</pub-date>
<volume>17</volume>
<elocation-id>418</elocation-id>
<history><date date-type="received"><day>3</day>
<month>4</month>
<year>2017</year>
</date>
<date date-type="accepted"><day>1</day>
<month>6</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>© The Author(s). 2017</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventive strategies in Cameroon.</p>
</sec>
<sec><title>Methods</title>
<p>This was a hospital–based case-control study carried out in the Bamenda Regional Hospital (BRH) between September 2015 and August 2016. Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature ≥ 38 °C) and/or chills of sudden onset. Controls were adults hospitalised for diseases other than cellulitis, necrotising fasciitis, myositis, abscess or other variants of dermo-hypodermitis. Cases and controls were matched (1:2) for age and sex.</p>
</sec>
<sec><title>Results</title>
<p>Of the 183 participants (61 cases of cellulitis and 122 controls) included in the study, the median age was 52 years [Interquartile range (IQR): 32.5–74.5]. After controlling for potential confounders, obesity [adjusted odds ratio (AOR) = 4.7, 95% CI (1.5–14.7); <italic>p</italic>
= 0.009], history of skin disruption [AOR = 12.4 (3.9–39.1); <italic>p</italic>
< 0.001], and presence of toe-web intertrigo [AOR = 51.4 (11.7–225.6); <italic>p</italic>
< 0.001] were significantly associated with cellulitis. Median hospital stay was longer (14 days [IQR: 6–28]) in cases compared to the controls (3 days [IQR: 2–7]). Among the cases, Streptococci species were the most frequent (<italic>n</italic>
= 50, 82%) isolated germ followed by staphylococci species (<italic>n</italic>
= 9, 15%). Patients with cellulitis were more likely to undergo necrosectomy (OR: 21.2; 95% CI: 7.6–59.2). Toe-web intertrigo had the highest (48.9%) population attributable risk for cellulitis, followed by history of disruption of skin barrier (37.8%) and obesity (20.6%).</p>
</sec>
<sec><title>Conclusion</title>
<p>This study showed a high disease burden among patients with cellulitis. While risk factors identified are similar to prior literature, this study provides a contextual evidence-base for clinicians in this region to be more aggressive in management of these risk factors to prevent disease progression and development of cellulitis.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Lower limb cellulitis</kwd>
<kwd>Risk factors</kwd>
<kwd>Disease burden</kwd>
<kwd>Cameroon</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2017</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
</record>
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