title: Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis.
abstract: Nonpurulent cellulitis is an acute bacterial infection of the dermal and subdermal tissues that is not associated with purulent drainage, discharge or abscess. The objectives of this systematic review and meta-analysis were to identify and appraise all controlled observational studies that have examined risk factors for the development of nonpurulent cellulitis of the leg (NPLC). A systematic literature search of electronic databases and grey literature sources was performed in July 2015. The Newcastle-Ottawa Scale (NOS) was used to assess methodological quality of included studies. Of 3059 potentially eligible studies retrieved and screened, six case-control studies were included. An increased risk of developing NPLC was associated with previous cellulitis [odds ratio (OR) 40·3, 95% confidence interval (CI) 22·6-72·0], wound (OR 19·1, 95% CI 9·1-40·0), current leg ulcers (OR 13·7, 95% CI 7·9-23·6), lymphoedema/chronic leg oedema (OR 6·8, 95% CI 3·5-13·3), excoriating skin diseases (OR 4·4, 95% CI 2·7-7·1), tinea pedis (OR 3·2, 95% CI 1·9-5·3) and body mass index > 30 kg m-2(OR 2·4, 95% CI 1·4-4·0). Diabetes, smoking and alcohol consumption were not associated with NPLC. Although diabetics may have been underrepresented in the included studies, local risk factors appear to play a more significant role in the development of NPLC than do systemic risk factors. Clinicians should consider the treatment of modifiable risk factors including leg oedema, wounds, ulcers, areas of skin breakdown and toe-web intertrigo while administering antibiotic treatment for NPLC.
authors.affiliation: Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, Ireland.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-4179-2748
authors.initials: M
authors.lastname: Quirke
authors.affiliation: Department of Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Ayoub
authors.affiliation: Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: McCabe
authors.affiliation: Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Boland
authors.affiliation: RCSI Library, Beaumont Hospital, Dublin, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Smith
authors.affiliation: Paediatric Emergency Care Research Unit (PERU), National Children's Research Centre, Dublin, Ireland.|School of Medicine, University College Cork, Cork, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: O'Sullivan
authors.affiliation: Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), 123 St Stephens Green, Dublin 2, Ireland.|Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Wakai
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D002481:Cellulitis / Q000209:etiology*; D006801:Humans; D007869:Leg Injuries / Q000150:complications; D007871:Leg Ulcer / Q000209:etiology; D008209:Lymphedema; D009765:Obesity / Q000150:complications; D064887:Observational Studies as Topic; D012008:Recurrence; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000209:etiology*; D012907:Smoking / Q000009:adverse effects; D014008:Tinea Pedis / Q000150:complications