Nav: Home

What are costs, consequences associated with misdiagnosed cellulitis?

November 02, 2016

Cellulitis is a common bacterial skin infection and a new study published online by JAMA Dermatology suggests misdiagnosis of the condition is associated with unnecessary hospitalizations and antibiotic use, as well as avoidable health care spending.

Cellulitis leads to about 2.3 million emergency department visits annually in the United States and between 14 percent and 17 percent of those patients are admitted to the hospital. However, many inflammatory conditions of the skin mimic cellulitis and are known as "pseudocellulitis."

Arash Mostaghimi, M.D., M.P.A., M.P.H., of the Brigham and Women's Hospital and Harvard Medical School, Boston, and coauthors examined the costs and consequences of misdiagnosed cellulitis. The authors examined data for patients admitted from the emergency department of a large urban hospital with a diagnosis of lower extremity cellulitis between June 2010 and December 2012. Patients were considered to have "pseudocellulitis" if they were given an alternative diagnosis during their hospital stay, on discharge or within 30 days of discharge.

The study included 259 patients, of whom 79 (30.5 percent) were misdiagnosed with cellulitis, and 52 of the misdiagnosed patients had been admitted primarily for the treatment of cellulitis. Among the 52 misdiagnosed patients, the average length of their hospital stay was nearly five days and 25 percent stayed longer than a week. A clinical review suggests that 44 of the 52 patients with misdiagnosed cellulitis would not have required hospital admission if they had been diagnosed correctly. Additionally, 48 (92 percent) of the 52 misdiagnosed patients would not have required any antibiotics based on their ultimate diagnoses, according to the report.

The authors estimate that misdiagnosed cellulitis leads to between 50,000 and 130,000 unnecessary hospitalizations and $195 million to $515 million in avoidable health care spending, not accounting for the costs of antibiotics and other complications that may result from unnecessary treatment. Unnecessary antibiotics and hospitalizations for misdiagnosed cellulitis also were projected to cause other serious infections, including Clostridium difficile, according to the article.

Study limitations include the generalizability of the findings because the investigation was conducted at a single institution. The authors used conservative estimates to present the range of costs and therefore may have underestimated the true cost of misdiagnosis.

"Our study serves as a call to arms for improving the care of patients with suspected lower extremity cellulitis. A combination of systems improvement and further categorization of the biology of cellulitis may lead to a combination of clinical findings and biomarkers that will reduce incorrect diagnosis," the study concludes.
(JAMA Dermatology. Published online November 2, 2016. doi:10.1001/jamadermatol.2016.3816. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

Related Antibiotics Articles:

Antibiotics promote resistance on experimental croplands
Canadian researchers have generated both novel and existing antibiotic resistance mechanisms on experimental farmland, by exposing the soil to specific antibiotics.
Why antibiotics fail
UCSB biologists correct a flaw in the way bacterial susceptibility to these drugs is tested.
Fungi have enormous potential for new antibiotics
Fungi are a potential goldmine for the production of pharmaceuticals.
Antibiotics can boost bacterial reproduction
The growth of bacteria can be stimulated by antibiotics, scientists at the University of Exeter have discovered.
Last-line antibiotics are failing
The ECDC's latest data on antimicrobial resistance and consumption shows that in 2015, antibiotic resistance continued to increase for most bacteria and antibiotics under surveillance.
Two antibiotics fight bacteria differently than thought
Two widely prescribed antibiotics -- chloramphenicol and linezolid -- may fight bacteria in a different way from what scientists and doctors thought for years, University of Illinois at Chicago researchers have found.
Preserving the power of antibiotics
News release describes efforts to address inappropriate antibiotic prescribing in emergency departments and urgent-care centers nationwide, which a JAMA study published this past May found rates as high as 50 percent for acute respiratory infections in US emergency departments.
Antibiotics could be cut by up to one-third, say dairy farmers
Nine in 10 dairy farmers participating in a new survey from the Royal Association of British Dairy Farmers (RADBF) say that the farming industry must take a proactive lead in the battle against antibiotic resistance.
Antibiotics may be inappropriate for uncomplicated diverticulitis
Antibiotics are advised in most guidelines on diverticulitis, which arises when one or more small pouches in the digestive tract become inflamed or infected.
New book on Antibiotics and Antibiotic Resistance from CSHLPress
'Antibiotics and Antibiotic Resistance' from CSHLPress examines the major classes of antibiotics, together with their modes of action and mechanisms of resistance.

Related Antibiotics Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Jumpstarting Creativity
Our greatest breakthroughs and triumphs have one thing in common: creativity. But how do you ignite it? And how do you rekindle it? This hour, TED speakers explore ideas on jumpstarting creativity. Guests include economist Tim Harford, producer Helen Marriage, artificial intelligence researcher Steve Engels, and behavioral scientist Marily Oppezzo.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".