Cellulitis in Patients with Cirrhosis and Edema: An Under-Recognized Complication Currently More Common than Spontaneous Bacterial Peritonitis

ABSTRACT

Cellulitis is often a recurring infection resulting in hospitalizations. In patients with cirrhosis, gram-negative bacilli may be causative.

Retrospective chart review of patients admitted to a dedicated Liver Unit in a tertiary referral center. Risk factors, characteristics and antibiotic treatment of patients with cirrhosis and edema complicated by cellulitis were compared to similar patients without cellulitis. We compared the frequency of cellulitis to that of spontaneous bacterial peritonitis in the same cohort. Our study is the largest case series focusing on the factors which predispose patients with cirrhosis to cellulitis.

Of 145 consecutive patients who were admitted to this unit during 1 year’s time, 19.3% were diagnosed with cellulitis compared to 4.1% diagnosed with spontaneous bacterial peritonitis. Cellulitis recurred in 21.4% of our patients. Significant risk factors for cellulitis included history of trauma or break in the skin barrier, homelessness, body mass index on admission and subjective degree of ascites and edema. Hospital stay was four days longer in patients with cellulitis, although this finding was not statistically significant. The duration of intravenous antibiotic treatment was 11.9 days.

The incidence and recurrence rates of cellulitis in patients with cirrhosis and edema are very high and appear to be higher than those of spontaneous bacterial peritonitis in the current era. The diagnosis of cellulitis remains a clinical one as laboratory values and body temperature may not reveal the diagnosis and wound cultures are not usually helpful. Optimal antibiotic treatment warrants further delineation as continued intravenous antibiotic treatment may prolong hospitalization.