title: Risk factors of cellulitis in cirrhosis and antibiotic prophylaxis in preventing recurrence.
abstract: BACKGROUND
  Cellulitis is a commonly encountered bacterial infection among cirrhotic patients apart from spontaneous bacterial peritonitis, urinary tract and respiratory infections. This study aimed to determine the risk factors of cellulitis in cirrhosis and whether antibiotic prophylaxis helps prevent recurrence of cellulitis.
  
  
  METHODS
  The study was conducted in two phases. In phase 1, all cirrhotic patients admitted with cellulitis from August 2011 to August 2013 were taken as cases (n=70) and cirrhotic patients without cellulitis were included as controls (n=73). Baseline demographic data, comorbidities and investigations were noted and compared. In phase 2, the cases of phase 1 were divided into two groups, based on initiation of antibiotic prophylaxis at the time of discharge and were followed up for six months for recurrence of cellulitis.
  
  
  RESULTS
  The main etiology of cirrhosis was alcohol and 68% of cases were Child C. Factors which showed significance in univariate analysis were presence of diabetes mellitus, hepatic encephalopathy, platelet count, albumin level and model for end-stage liver disease (MELD) score. Using logistic regression, hepatic encephalopathy (OR 2.95, CI 1.01-8.45), albumin level <2.5 g/dL (OR 2.80, CI 1.32-5.92) and MELD >15 (OR 2.95, CI 1.39-6.27) emerged as significant factors associated with cellulitis. Cellulitis recurred in 20% and recurrence was significantly low among antibiotic prophylaxis group (15% vs. 50% P=0.048).
  
  
  CONCLUSIONS
  Hypoalbuminemia, and high MELD score are the risk factors for cellulitis in cirrhosis. Antibiotic prophylaxis can reduce the recurrence of cellulitis as in the case of spontaneous bacterial peritonitis.
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Rooby Erachamveettil
authors.initials: RE
authors.lastname: Hamza
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Mashhood Padincharepurathu
authors.initials: MP
authors.lastname: Villyoth
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: George
authors.initials: G
authors.lastname: Peter
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Deni
authors.initials: D
authors.lastname: Joseph
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Chethan
authors.initials: C
authors.lastname: Govindaraju
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Devang Chandrakanth
authors.initials: DC
authors.lastname: Tank
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Sreejaya
authors.initials: S
authors.lastname: Sreesh
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Premalatha
authors.initials: P
authors.lastname: Narayanan
authors.affiliation: Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India.
authors.forename: Kattoor Ramakrishnan
authors.initials: KR
authors.lastname: Vinayakumar
keywords: Cellulitis; antibiotic prophylaxis; cirrhosis; recurrence; risk factors