The Effect of Histopathologic Analysis and Tissue Cultures on Inpatient Management of Cellulitis: a Randomized Control Trial

Abstract Background. In the absence of a gold-standard diagnostic modality for cellulitis, sterile inflammatory disorders may be misdiagnosed as cellulitis.Objective. To determine the utility of skin biopsy and tissue culture for the diagnosis and management of patients admitted with a diagnosis of cellulitis. Design. Pilot, single-blind parallel group randomized controlled clinical trial evaluating length of stay and antibiotic use in 56 patients with a primary diagnosis of cellulitis. Skin biopsy and tissue culture results were only reported in the intervention group. Corollary analysis of adipose tissue inflammation and structural changes in cellulitis. Results. Hospital length of stay showed the greatest opportunity for further study as a primary outcome (intervention: 4, IQR (2-6) vs control: 5 IQR (3-8) days; p = 0.124). In the corollary study, there were differentially expressed genes related to inflammation (CD74), macrophage characterization (CD14, MCP1, CD36) and extracellular matrix proteins (VEGFA, FGF1, FGFR1/3, TIMP1, COL12A1) in the adipose tissue of chronic cellulitis patients.Limitations. Limited number of participants.Conclusion. The study demonstrated that hospital length of stay and anti-pseudomonal antibiotic de-escalation are endpoints worth further study. The corollary study demonstrated multiple inflammatory and structural genes that are upregulated in this disease process.