Potential factors associated with increased chance of erysipelas recurrence

Retrospective cohort study with 235 adults and older adults admitted to a hospital diagnosed with erysipelas between 2012 and 2019. Sociodemographic and clinical factors related to a greater chance of erysipelas recurrence in the period were investigated through uni and bivariate analyses, with p<0.05 considered significant.

Results

The prevalence of erysipelas recurrence was 25.5% (n=60). Factors significantly associated with recurrence were venous insufficiency (p= 0.002; OR= 2.597; 95%CI= 1.4-4.7) and use of penicillin (p< 0.000; OR= 7.042; 95%CI= 2.5-19.7).

Conclusion

venous insufficiency is associated with a twice greater chance of erysipelas recurrence and the use of penicillin is associated with a seven times greater risk for its recurrence.

Erysipelas; Health of the elderly; Wounds and injuries; Recurrence

Profile of patients with erysipelas	Total (n = 235)	Adults (n = 48)	Older adults (n = 187)
Profile of patients with erysipelas	n(%)	n(%)	n(%)
Age range
Up to 29 years old	3(1.3)	3(6.2)	-
30 to 39 years old	4(1.7)	4(8.3)	-
40 to 49 years old	18(7.7)	18(37.5)	-
50 to 59 years old	23(9.8)	23(47.9)	-
60 to 69 years old	71(30.2)	-	71(38.0)
70 to 79 years old	75(31.9)	-	75(40.1)
80 years old or more	41(17.4)	-	41(21.9)
Gender
Male	120(51.1)	24(50.0)	96(51.3)
Female	115(48.9)	24(50.0)	91(48.7)
Affected Site
Left lower limb	93(39.6)	23(47.9)	70(37.4)
Right lower limb	91(38.7)	20(41.7)	71(38.0)
Both lower limbs	44(18.7)	4(8.3)	40(21.4)
Right upper limb	3(1.3)	1(2.1)	2(1.1)
Left upper limb	3(1.3)	-	3(1.6)
Both upper limbs	1(0.4)	-	1(0.5)
Entry
No registry *	62(26.4)	14(29.2)	48(25.7)
Traumas	48(20.4)	9(18.8)	39(20.9)
Ulcers	38(16.2)	6(12.5)	32(17.1)
Wounds	34(14.5)	6(12.5)	28(15.0)
Ringworm	30(12.8)	9(18.8)	21(11.2)
Surgical wound	10(4.3)	2(4.2)	8(4.3)
Bug bite	5(2.1)	2(4.2)	3(1.6)
Others**	8(4.3)	-	8(4.3)
Life habits
Active drinker	21(8.9)	4(8.3)	17(9.1)
Active smoker	14(6.0)	-	14(7.5)
Polypharmacy
Yes	73(31.1)	13(27.1)	60(32.1)
Number of antibiotics used
Mean (SD***)	3.0(SD= 1.501)	3.1(SD= 1.453)	3.0(SD = 1.515)
Median (25%, 75%)	3(2.4)	3(2.4)	3(2.4)
Number of days of antibiotic therapy
Mean (SD)	16.8(SD = 10.008)	16.9(SD = 9.636)	16.8(SD = 10.127)
Median (25%, 75%)	14 (10.20)	16(10.22)	14(10.20)

Variables	With recurrence (n= 60) n (%)	Without recurrence (n = 175) n (%)	Odds Ratio	95%CI		p-value*
Variables	With recurrence (n= 60) n (%)	Without recurrence (n = 175) n (%)	Odds Ratio	Inferior limit	Superior limit	p-value*
Comorbidities
Systemic arterial hypertension	49(81.7)	131(74.9)	1.496	0.715	3.129	0.282
diabetes mellitus	28(46.7)	86(49.1)	0.906	0.503	1.629	0.741
Obesity	18(30.0)	39(22.3)	1.495	0.775	2.883	0.229
Venous insufficiency	33(55.0)	56(32.0)	2.597	1.426	4.731	0.002
Gender
Male	30(50.0)	90(51.4)	0.944	0.525	1.698	0.849
Female	30(50.0)	85(48.6)	-	-	-	-
Age range
Older adults	49(81.7)	138(78.9)	1.194	0.565	2.523	0.641
Adults	11(18.3)	37(21.1)	-	-	-	-
Life habits
Drinker	5(8.3)	16(9.1)	0.903	0.316	2.581	0.850
Smoker	6(10.0)	8(4.6)	2.319	0.770	6.982	0.125
Using medication
Yes	51(86.4)	138(80.7)	1.524	0.660	3.519	0.321
Polypharmacy
Yes	24(40.0)	49(28.0)	1.714	0.929	3.164	0.083

Variables	With recurrence (n= 60) n(%)	Without recurrence (n= 175) n(%)	Odds Ratio	95%CI		p-value*
Variables	With recurrence (n= 60) n(%)	Without recurrence (n= 175) n(%)	Odds Ratio	Inferior limit	Superior limit	p-value*
Signs and symptoms
Fever	34(56.7)	86(49.1)	1.353	0.750	2.442	0.314
Local pain	48(80.0)	124(70.9)	1.645	0.807	3.352	0.168
Edema	52(86.7)	144(82.3)	1.399	0.604	3.239	0.431
Hyperemia	47(78.3)	146(83.4)	0.718	0.670	2.896	0.374
Bubbles	19(31.7)	76(43.4)	0.604	0.325	1.123	0.109
Affected site
Both lower limbs	12(20.0)	32(19.0)	1.063	0.507	2.228	0.873
One lower limb	48(80.0)	136(81.0)	-	-	-	-
Number of antibiotics
2 or more	52(86.7)	152(86.9)	0.984	0.415	2.333	0.970
1	8(13.3)	23(13.1)	-	-	-	-
Number of days antibiotic therapy
15 or more	29(48.3)	86(49.1)	0.968	0.538	1.741	0.914
Up to 14	31(51.7)	89(50.9)
Antibiotics used
Ciprofloxacin	14(23.3)	41(23.4)	0.995	0.497	1.989	0.998
Clindamycin	23(38.3)	54(30.9)	1.393	0.756	2.567	0.287
Amoxicillin + clavulanate	29(48.3)	74(42.3)	1.277	0.709	2.300	0.415
Moxifloxacin	20(33.3)	55(31.4)	1.091	0.584	2.037	0.785
Penicillin	12(20.0)	6(3.4)	7.042	2.511	19.745	< 0.000
Trimethoprim + sulfamethoxazole	18(30.0)	57(32.6)	0.887	0.470	1.676	0.712

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author Etiene Souza Madeira Email: souza.etiene@gmail.com