Journal article
Diagnostic stewardship and dermatology consultation in cellulitis management: a systematic literature review and meta-analysis
Archives of dermatological research, Vol.317(1), 61
11/30/2024
DOI: 10.1007/s00403-024-03515-x
PMID: 39614879
Abstract
Cellulitis is a common skin infection often requiring antibiotic treatment. However, misdiagnosis and inappropriate antibiotic use contribute to antibiotic resistance and healthcare costs. We aimed to evaluate the impact of dermatology consultation on treatment modification in patients with suspected cellulitis and to determine whether dermatologists' evaluation can be used as a reference to diagnose suspected cellulitis. We explored MedLine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane CENTRAL, Web of Science, and Scopus and Embase, including publications from database inception to July 25, 2023. Studies were included if they evaluated treatment modifications involving the use of antibiotics for patients with suspected cellulitis with and without dermatology consultation. We excluded comments or reviews, pilot studies, and studies without a non-dermatology control group, treatment modifications, the use of antibiotics, or patients with cellulitis. Of the 49 full-text articles, 14 studies met the selection criteria.This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Of five independent reviewers (GYC, IP, MG, MKH, and AMRP), two abstracted data for each article using a standardized abstraction form. We used the Downs and Black scale to evaluate study quality. Subgroup analysis was conducted regarding readmission rate within 30 days for two independent populations seen by a non-dermatologist physician or a dermatologist. We employed random-effects models to obtain pooled mean differences. Heterogeneity was assessed using the I-squared value. The impact of dermatology consultation on treatment modification involving antibiotics in patients with suspected cellulitis and readmission rates in 30 days. Dermatology consultation changed initial treatment plans involving antibiotics from 47 to 96% of the time, improving diagnostic accuracy and, consequently, antibiotic stewardship of cellulitis. Dermatology consultation was not significantly associated with lower readmission rates in 30 days (pooled OR = 0.56, 95% CI: 0.25 to 1.25, I2 = 0%). Dermatology consultation in patients with suspected cellulitis may improve diagnosis and management, thereby reducing antibiotic misuse, unnecessary tests, and prolonged hospitalizations.
Details
- Title: Subtitle
- Diagnostic stewardship and dermatology consultation in cellulitis management: a systematic literature review and meta-analysis
- Creators
- Vivian Lin - Hospital Israelita Albert EinsteinGustavo Yano Callado - Hospital Israelita Albert EinsteinIsabele Pardo - Hospital Israelita Albert EinsteinMaria Gutfreund - Hospital Israelita Albert EinsteinMariana Kim Hsieh - Hospital Israelita Albert EinsteinAndrea Mendes Rodrigues Pereira - Hospital Israelita Albert EinsteinBernice Y Kwong - Stanford UniversityMaria Aleshin - Stanford UniversityMarisa Holubar - Stanford UniversityJorge L Salinas - Stanford UniversityDaniel J Diekema - University of IowaAlexandre R Marra - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Archives of dermatological research, Vol.317(1), 61
- Publisher
- Springer Nature
- DOI
- 10.1007/s00403-024-03515-x
- PMID
- 39614879
- ISSN
- 0340-3696
- eISSN
- 1432-069X
- Grant note
- Instituto Israelita de Ensino e Pesquisa (IIEP) of Hospital Israelita Albert Einstein
We thank Kioko Kusuki de Oliveira, librarian from Instituto Israelita de Ensino e Pesquisa (IIEP) of Hospital Israelita Albert Einstein (HIAE), for her invaluable assistance in defining our research strategy.
- Language
- English
- Date published
- 11/30/2024
- Academic Unit
- Infectious Diseases; Internal Medicine
- Record Identifier
- 9984756241702771
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