Anagha Vasant
Cellulitis is a potentially serious infection of the skin and underlying tissues, affecting approximately 1 in 40 people annually in the UK. The Dundee classification system and NICE guidelines offer structured frameworks for its management, emphasizing appropriate classification, antibiotic duration, and risk stratification. This audit evaluates current practices and identifies deviations from these standards within a secondary care setting.
Aim
1.To assess adherence to the Dundee classification system and trust guidelines.
2.To identify causes for prolonged antibiotic use (>7 days).
3.To propose a revised, patient-tailored management pathway.
Methodology
A retrospective review of 200 cellulitis cases treated in 2023 was conducted. Management was assessed against the Dundee classification and local guidelines, with a focus on classification accuracy, treatment duration, recurrence prevention, and risk factor identification.
Results:
- 56% of cases were not concordant with the Dundee classification system.
- 39% of Class 1 patients were overtreated, with 10.9% experiencing significant antibiotic-related side effects.
- 56% of Class 2 and 3 cases were undertreated, resulting in a 71% recurrence rate.
Recommendations
1.Implement a revised pathway combining trust guidelines with a modified Dundee classification.
2.Include diabetes and lymphedema as key risk factors in the revised system.
3.Conduct a follow-up audit to assess the effectiveness of changes.
Conclusion
This audit demonstrates notable deviation from evidence-based guidelines, leading to suboptimal outcomes. Targeted interventions and a revised protocol may improve classification accuracy, reduce recurrence, and optimize patient care.
Authors
Anagha Vasant
Ashford and st peter’s hospital, Surrey, United Kingdom
Pooja Manjula
Ashford and st peter’s hospital, Surrey, United Kingdom
Samyojana Gurung
Ashford and st peter’s hospital, Surrey, United Kingdom
Ayesha Hamid
Ashford and st peter’s hospital, Surrey, United Kingdom