# The effect of histopathologic analysis and tissue cultures on inpatient management of cellulitis: a randomized control trial

## TL;DR

This study explores whether skin biopsies and tissue cultures help improve the management of patients with suspected cellulitis.

## Contribution

It is the first randomized trial to assess the impact of histopathology and tissue culture on inpatient cellulitis management.

## Key findings

- Length of hospital stay was shorter in the intervention group, though not statistically significant.
- Biopsy and culture results influenced antibiotic de-escalation decisions.
- The study highlights the need for further research on these diagnostic tools in cellulitis management.

## 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 presumed cellulitis. Design: Pilot single-blind parallel group randomized controlled clinical trial in 56 patients with a primary diagnosis of presumed cellulitis. In the intervention group only, skin biopsy and tissue culture results were made available to the primary care team to guide diagnosis and management. Length of hospital stay and antibiotic use were evaluated as outcome measures. Results: 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). Limitations: The COVID-19 pandemic placed limitations on participant enrollment and study duration; in addition, data was collected from a single medical center. Conclusion: This study demonstrates that length of stay and anti-pseudomonal antibiotic de-escalation are endpoints that may be influenced by biopsy and tissue culture results in presumed cellulitis patients; these outcomes warrant further study.