| Sažetak | Ciljevi: Cilj ovog rada je bio istražiti glavne predispozicijske čimbenike bolesnika s celulitisom, istražiti koji su laboratorijski nalazi i slikovne metode najkorisniji za dijagnosticiranje celulitisa, koliko često se javljaju komplikacije u bolesnika s celulitisom te koje regije celulitis najčešće zahvaća.
Ispitanici i metode: U istraživanje je uključeno 125 pacijenata s dijagnozom celulitisa koji su liječeni na Klinici za infektivne bolesti kliničkog bolničkog centra Split u periodu 2016.-2017. godine. Podatke su prikupljeni istraživanjem pisanog protokola Klinike za infektivne bolesti KBC-a Split te arhive povijesti bolesti, a nakon toga obrađeni u programskim paketima Microsoft Office i Microsoft Excel.
Rezultati: Prosječna dob bolesnika bila je 63 godine (raspon 4- 90). Prosječna dob za muškarce bila je 56,6 godina (raspon 4- 85), a prosječna dob za žene je 70 godina (raspon 43- 90). Najviše bolesnika 76/125 (60,8%) bilo je u dobi iznad 60 godina. Komorbiditet je imalo 115 od ukupno 125 naših bolesnika, a više od jednog komorbiditeta je imalo 56/125 (44,8%) bolesnika. Najzastupljeniji jesu stare ozljede i operacije, u 59/125 (47,2%). CRP je bio povišen u svih bolesnika. U 81 bolesnika vrijednost CRP bila je viša od 100 mg/L. Slikovne metode su primijenjene kod 21/125 pacijenata s tim da je najučestalije korišten ultrazvuk 14/21 (66,6%). Ishod nalaza slikovnih pretraga je negativan kod svih pacijenata. Komplikacije su se javile u 7/125 pacijenata. U 5/7 pacijenata imamo lokalne komplikacije (apsces, nekroza ulkusa, gangrena stopala), a u 2 pacijenta sistemne komplikacije (bakterijemija/sepsa). Pojava celulitisa je najčešća na donjim ekstremitetima (natkoljenica i potkoljenica), čak njih 100/125 (80,0%). Etiologija najčešće ostaje neutvrđena, u 102/125 bolesnika. Kod četiri bolesnika je bila pozitivna hemokultura, s tim da je samo kod jednog pacijenta izolirano više bakterija (E. coli, MRSA, S. pyogenes). Iz brisa rane su najčešće izolirane sljedeće bakterije: MSSA, P. aeruginosa i E. coli, a kod njih 10/19 izolirano je više bakterija. Najčešće korištena inicijalna terapija bila je benzilpenicilin 67/125 (53,6%).
Zaključci: Većina naših ispitanika s celulitisom bile su osobe starije od 60 godina. Osim dobi, najčešći predispozicijski čimbenici jesu stare ozljede i dijabetes melitus. CRP i neutrofilija su pouzdaniji parametri za dijagnozu celulitisa od povišenog broja leukocita, a slikovne metode se u ovom radu nisu pokazale korisnima. Komplikacije, uključujući i lokalne i sistemne, kod celulitisa su relativno rijetke. Sukladno našim očekivanjima, celulitisi se najčešće javljaju na donjim ekstremitetima. U najvećeg broja bolesnika etiološka dijagnostika ostaje neutvrđena, ali s obzirom na poznate najčešće uzročnike terapija se zasniva na beta- laktamima. |
| Sažetak (engleski) | Objectives: The aim of this study was to analyze main predisposition factors of patients with cellulitis using lab findings and medical image methods which are most proper to cellulitis diagnosis, the incidence of complications and which regions are mostly affected with cellulitis.
Subjects and Methods: The study included 125 patients diagnosed with cellulitis treated at the Clinic for Infectious Diseases of University Hospital of Split in the period 2016 - 2017. The data were collected by investigating the written protocol of the Clinic for Infectious diseases of University Hospital of Split and the history of the disease, and then processed in the Microsoft Office and Microsoft Excel program packages.
Results: The average age of the patient was 63 (range 4-90). The average age for men was 56.6 (range 4-85), and the average age for women was 70 (range 43-90) years. Most patients 76/125 (60.8%) were over 60 years of age. Co-morbidity had 115 out of 125 patients, and more than one co-morbidity had 56 out of 125 (44.8%) patients. The most common are old injuries and operations, 59 out 125 cases (47,2%). CRP was elevated in all patients. In 81 patients the CRP value was higher than 100 mg / L. Medical imaging methods were used in 21 out of 125 patients with accent on ultrasound. It has been used in 14 out of 21 cases (66,6%). The final result of medical imaging methods were negative in accordance of all patients. Complications occurred in 7/125 patients. Local complications (abscess, ulcer necrosis, foot gangrene) were present in 5/7 patients, and systemic complications (bacteriemia / sepsis) in 2/7 patients. The occurrence of cellulitis is most commonly found at the lower extremities (thigh and lower leg), even 100 out of 125 (80.0%). Etiology most commonly comes unnoticed in 102 out of 125 patients. Four patients had positive blood culture, within that only one patient had more isolated bacteria (E. coli, MRSA, S. pyogenes). Isolated bacteria in most cases were: MSSA, P. aeruginosa i E. coli. 10 out of 19 cases had more isolated bacteria. The most common initial therapy that was used was benzylpenicillin. 67 out of 125 cases (53,6%).
Conclusions: Most of our subjects with cellulitis were persons over the age of 60. Apart from age, the most common predisposing factors are old injuries and diabetes mellitus. CRP and neutrophils are more reliable parameters for the diagnosis of cellulitis than the higher number of leukocytes, and the methods of medical imaging in this case have not proved to be useful. Complications, including local and systemic, are relatively rare in cellulite. According to our expectations, cellulite usually occurs at the lower extremities. In most patients, etiologic diagnosis remains undetermined. But due to known of common causes, therapy is based on beta - lactams. |
