RISK FACTORS ASSOCIATED WITH ACUTE AND RECURRENT LOWER LIMB CELLULITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Cellulitis is a bacterial skin infection affecting the deep dermal and subcutaneous layers. It occurs when pathogens enter the dermis through disruptions in the skin barrier and is most commonly present in the lower limbs. Previous reviews did not include recurrent cellulitis and had small numbers of included studies. Objective: To review and summarize the risk factors associated with acute and recurrent lower limb cellulitis (LLC) in published literature Methods: A systematic literature search was conducted on Cochrane CENTRAL, PubMed, EMBASE, PsycINFO, ProQuest Dissertations and Theses, MEDLINE, Scopus, and CINAHL, from inception up to January 2021. Only English-language studies were included. Two reviewers independently retrieved and screened the studies against an inclusion criterion, extracted relevant data and assessed the methodological quality with Newcastle-Ottawa Scale. Meta-analysis was performed with RevMan software. Overall effect was assessed using odd ratios and risk ratios. Chi2 test and I2 statistics were used to assess heterogeneity. Results: 19 observational studies were included in this review. The results revealed that overweight and obesity, leg edema or lymphoedema, current leg ulcer, previous cellulitis, previous leg surgery, tinea pedis or toe-web intertrigo, and traumatic wound were associated risk factors of acute LLC. Meanwhile risk factors such as congestive heart failure, diabetes mellitus, obesity, leg edema or lymphoedema, leg surgery, onychomycosis, peripheral vascular disease, skin disease, tinea pedis and venous insufficiency were associated with recurrent LLC. Significance of Study: This review provided a comprehensive summary on the existing evidence regarding the risk factors associated with acute and recurrent LLC. Clinical implication includes implementation of strategies targeted at the eradication of the risk factors to prevent recurrence. Future research includes investigating the effectiveness of those preventive strategies in reducing recurrence rate.