title: Cutaneous infections, good use of antibiotics and diagnostic accuracy.
abstract: The medical dashboard (DB) recording our clinical practices indicated on one hand the use of two different diagnosis terms, acute dermohypodermitis (ADH) or cellulitis, and on the other hand, an important antibiotic prescription heterogeneity. Our aim was to define these two diagnosis groups and to document compliance to our antibiotic therapy protocol.
  
  
  METHODS
  ADH and cellulitis were selected in our medical DB that records all patient data. Our local antibiotic therapy protocol was designed in April 2009; the prescription of recommended antibiotic agents defined the compliance to recommendations. The patient files indicating non-consensual therapy were analyzed to determine the reasons for inappropriate prescription.
  
  
  RESULTS
  Three hundred and four cases of ADH and 82 of cellulitis were diagnosed over 6.5years. ADH was associated with older age (P=0.007), a higher frequency of venous insufficiency (P=0.015), a lower frequency of cancer (P=0.007), and was more often located on lower limbs (P<0.001), compared to cellulitis. The diagnosis of ADH was associated with higher compliance to our antibiotic therapy protocol, compared to cellulitis: 68% versus (vs.) 24%, P<0.001, and after April 2009: 53% vs. 64%, P=0.033. Among the 162 inappropriate antibiotic prescriptions (42%), 75 were deemed justified after analyzing the patient file, but less frequently for ADH compared to cellulitis: 49% vs. 11,5%, P<0.001.
  
  
  CONCLUSIONS
  ADH presents different clinical characteristics compared to cellulitis. The antibiotic therapy protocol for ADH cannot be applied to cellulitis.
authors.affiliation: Infectiologie, université de Nice-Sophia-Antipolis, hôpital de l'Archet 1, centre hospitalier universitaire de Nice, Nice, France. roger.pm@chu-nice.fr
authors.forename: P M
authors.initials: PM
authors.lastname: Roger
authors.forename: K
authors.initials: K
authors.lastname: Risso
authors.forename: F
authors.initials: F
authors.lastname: de Salvador
authors.forename: C
authors.initials: C
authors.lastname: Pulcini
authors.forename: V
authors.initials: V
authors.lastname: Mondain
authors.forename: E
authors.initials: E
authors.lastname: Bernard
authors.forename: E
authors.initials: E
authors.lastname: Cua
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012874:Skin Diseases, Infectious / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents