• Ailbhe Kiely, Elwahab Sami Abd SA Department of Surgery, Wexford General Hospital, Wexford, Ireland., Declan McDonnell, Roisin Tully, Maria Randles, Mary Hickey, Felix Ofori-Kuma, Ivan Ivanovski, Suhail Khan, Karl Schmidt, and Kenneth Mealy.
• Department of Plastic Surgery, St Thomas's Hospital, Westminster Bridge Road, London, SE1 7EH, UK. kielya1@tcd.ie.
• Ir J Med Sci. 2020 Feb 1; 189 (1): 245-249.

Background/AimsApplication of evidence-based guidelines in the management of cellulitis is poorly studied in Ireland and it is observed that current admission and prescription practices in this country vary widely from internationally accepted standards of care. We aimed to examine the management of cellulitis with regard to hospital admission and initial antibiotic therapy.MethodsA retrospective audit of patients admitted with cellulitis from 2013 to 2017 in an Irish district general hospital. Exclusion criteria included specialist regions of the body and surgical site infections. Appropriateness of admission and management was compared against international guidelines (Clinical Research Efficiency Support Team (CREST) and Infectious Disease Society of America (IDSA)).ResultsFive hundred twenty emergency admissions with cellulitis were analysed. Thirty-five percent (n = 182) were deemed inappropriate admissions compared with CREST and IDSA guidelines, with an estimated cost of €152,203 per annum. Ninety-six percent (n = 501) of patients with cellulitis were treated with a combination of flucloxacillin and benzylpenicillin, despite level 1 evidence showing combination therapy to provide no benefit over appropriate monotherapy.ConclusionsThere is a significant discrepancy between current clinical practice and international guidelines for the management of cellulitis in Ireland; local guidelines are not in keeping with newer evidence and there is a lack of national guidelines for this common condition. Closer adherence to international guidelines would significantly reduce costs by reducing unnecessary admissions and initial monotherapy would improve antibiotic stewardship. This study shows a clear need for local institutions to re-examine antibiotic guidelines to ensure the HSE provides effective evidence-based treatment in the correct setting.

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