Infectious diseases specialist management improves outcomes for outpatients diagnosed with cellulitis in the emergency department: a double cohort study

•Automatic ID consultation for cellulitis diagnosed in the emergency room was implemented.•ID consultation reduced hospitalization and disease recurrence.•ID consultation led to earlier narrowing of the antibiotic spectrum.•ID consultation identified cellulitis mimickers allowing for care of the true issue.•ID consultation led to identification and treatment of predisposing conditions.

Three hospital emergency rooms (ERs) routinely referred all cases of cellulitis requiring outpatient intravenous antibiotics, to a central ER-staffed cellulitis clinic. We performed a retrospective cohort study of all patients seen by the ER clinic in the last 4 months preceding a policy change (ER management cohort [ERMC]) (n = 149) and all those seen in the first 3 months of a new policy of automatic referral to an infectious disease (ID) specialist-supervised cellulitis clinic (ID management cohort [IDMC]) (n = 136). Fifty-four (40%) of 136 patients in the IDMC were given an alternative diagnosis (noncellulitis), compared to 16 (11%) of 149 in the ERMC (P < 0.0001). Logistic regression-demonstrated rates of disease recurrence were lower in the IDMC than the ERMC (hazard ratio [HR], 0.06; P = 0.003), as were rates of hospitalization (HR, 0.11; P = 0.01). There was no significant difference in mortality. Automatic ID consultation for cellulitis was beneficial in differentiating mimickers from true cellulitis, reducing recurrence, and preventing hospital admissions.