{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T20:23:10Z","timestamp":1772223790203,"version":"3.50.1"},"reference-count":20,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2019,10,11]],"date-time":"2019-10-11T00:00:00Z","timestamp":1570752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002836","name":"Chang Gung University","doi-asserted-by":"publisher","award":["CMRP number CIRPD1D0032"],"award-info":[{"award-number":["CMRP number CIRPD1D0032"]}],"id":[{"id":"10.13039\/501100002836","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015835","name":"Department of Health, Taipei City Government","doi-asserted-by":"publisher","award":["number107XDAA00099"],"award-info":[{"award-number":["number107XDAA00099"]}],"id":[{"id":"10.13039\/501100015835","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Cellulitis is a complication of acupuncture, but the risk factors and annualized incidence remain unclear. Objective: This study analyzed the incidence and risk factors of cellulitis related to acupuncture in a cohort of one million participants derived from Taiwan\u2019s Longitudinal Health Insurance Database. Methods: We tracked this cohort between 1997 and 2012 and recorded all outpatient medical information including diagnosis and treatment. Patients were categorized according to age, gender, comorbidities, residential area, and number of acupuncture treatments. We compared the incidence and risk of cellulitis between different demographics and comorbidities by logistic regression analysis and adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Results: We included 407,802 patients and 6,207,378 acupuncture treatments. The incidence of cellulitis after acupuncture was 64.4 per 100,000 courses of acupuncture treatment. The most common sites of cellulitis after acupuncture were the legs, feet, and face. Comorbidity was associated with post-acupuncture cellulitis; a multivariate logistic regression analysis showed that chronic kidney disease (aOR, 1.71; 95% CI, 1.55\u20131.88), rheumatoid arthritis (aOR, 1.86; 95% CI, 1.21\u20133.60), liver cirrhosis (aOR, 1.23; 95% CI, 1.15\u20131.32), diabetes mellitus (aOR, 1.69; 95% CI, 1.57\u20131.82), stroke (aOR, 1.44; 95% CI, 1.31\u20131.58), varicose veins (aOR, 2.38; 95% CI, 2.17\u20132.84), or heart failure (aOR, 1.81; 95% CI, 1.65\u20131.98) significantly increased cellulitis. Repeated exposure to acupuncture treatment was associated with an increased risk of cellulitis. Conclusions: A variety of chronic diseases may increase the risk of cellulitis after acupuncture. Physicians asked about past medical history before acupuncture might help to reduce cellulitis.<\/jats:p>","DOI":"10.3390\/ijerph16203831","type":"journal-article","created":{"date-parts":[[2019,10,11]],"date-time":"2019-10-11T10:53:03Z","timestamp":1570791183000},"page":"3831","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Incidence of Cellulitis Following Acupuncture Treatments in Taiwan"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0067-2280","authenticated-orcid":false,"given":"Shun-Ku","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Chinese Medicine, Taipei City Hospital, Renai Branch, Taipei 106, Taiwan"},{"name":"Institute of Public Health, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3868-085X","authenticated-orcid":false,"given":"Jui-Ming","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan"},{"name":"Department of Medicine, National Yang-Ming University, Taipei 112, Taiwan"},{"name":"Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pin-Hsuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Chinese Medicine, Taipei City Hospital, Renai Branch, Taipei 106, Taiwan"},{"name":"Department of Chinese Medicine, China Medical University, Taichung 404, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng-Ping","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Chinese Medicine, Taipei City Hospital, Renai Branch, Taipei 106, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren-Jun","family":"Hsu","sequence":"additional","affiliation":[{"name":"Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan"},{"name":"Cancer Medicine Center of Buddhist Hualien Tzu Chi Hospital, Tzu Chi University, Hualien 970, Taiwan"},{"name":"Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heng-Chang","family":"Chuang","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8245-4302","authenticated-orcid":false,"given":"Po-Hung","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan"},{"name":"Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1136\/aim.19.2.84","article-title":"British Medical Acupuncture Society and Acupuncture Association of Chartered Physiotherapists. Survey of adverse events following acupuncture (SAFA): A prospective study of 32,000 consultations","volume":"19","author":"White","year":"2001","journal-title":"Acupunct. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e164","DOI":"10.3346\/jkms.2018.33.e164","article-title":"Infectious Adverse Events Following Acupuncture: Clinical Progress and Microbiological Etiology","volume":"33","author":"Kim","year":"2018","journal-title":"J. Korean Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1159\/000209315","article-title":"Safety of acupuncture: Results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form","volume":"16","author":"Witt","year":"2009","journal-title":"Complement. Med. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1136\/aim.19.2.93","article-title":"A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists","volume":"19","author":"MacPherson","year":"2001","journal-title":"Acupunct. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Xu, S., Wang, L., Cooper, E., Zhang, M., Manheimer, E., Berman, B., Shen, X., and Lao, L. (2013). Adverse events of acupuncture: A systematic review of case reports. Evid. Based Complement. Alternat. Med., 581203.","DOI":"10.1155\/2013\/581203"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1001\/jama.2016.8825","article-title":"Cellulitis: A Review","volume":"316","author":"Raff","year":"2016","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e4917","DOI":"10.1097\/MD.0000000000004917","article-title":"Traditional Chinese medicine therapy decreases the pneumonia risk in patients with dementia","volume":"95","author":"Lin","year":"2016","journal-title":"Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13020-016-0086-9","article-title":"Patterns of Chinese medicine use in prescriptions for treating Alzheimer\u2019s disease in Taiwan","volume":"11","author":"Lin","year":"2016","journal-title":"Chin. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jep.2017.03.040","article-title":"Traditional Chinese medicine therapy reduces the catheter indwelling risk in dementia patients with difficult voiding symptoms","volume":"203","author":"Lin","year":"2017","journal-title":"J. Ethnopharmacol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.healthpol.2011.08.007","article-title":"Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan","volume":"103","author":"Lin","year":"2011","journal-title":"Health Policy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"245","DOI":"10.2147\/TCRM.S123702","article-title":"Increased risk of endotracheal intubation and heart failure following acute myocardial infarction in patients with urolithiasis: A nationwide population-based study","volume":"13","author":"Lin","year":"2017","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jep.2014.05.049","article-title":"The traditional Chinese medicine prescription patterns of Sj\u00f6gren\u2019s patients in Taiwan: A population-based study","volume":"155","author":"Yu","year":"2014","journal-title":"J. Ethnopharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1001\/archinte.167.7.709","article-title":"A predictive model of recurrent lower extremity cellulitis in a population-based cohort","volume":"167","author":"McNamara","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"493","DOI":"10.7326\/0003-4819-97-4-493","article-title":"Recurrent cellulitis after saphenous venectomy for coronary bypass surgery","volume":"97","author":"Baddour","year":"1982","journal-title":"Ann. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1017\/ice.2018.354","article-title":"Acupuncture-associated infections: A matter of concern in China","volume":"40","author":"Zhou","year":"2019","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s11938-019-00229-2","article-title":"Infections in Cirrhosis","volume":"17","author":"Ekpanyapong","year":"2019","journal-title":"Curr. Treat. Opt. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/liv.13515","article-title":"Incidence, predictive factors and impacts of acute kidney injury in cirrhotic patients hospitalized for cellulitis","volume":"38","author":"Tellez","year":"2018","journal-title":"Liver Int."},{"key":"ref_18","first-page":"1844","article-title":"Risk factors for early wound complications after orthopedic surgery for rheumatoid arthritis","volume":"22","author":"Escalante","year":"1995","journal-title":"J. Rheumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.cmi.2018.01.024","article-title":"Severe lower limb cellulitis: Defining the epidemiology and risk factors for primary episodes in a population-based case-control study","volume":"24","author":"Cannon","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","first-page":"109","article-title":"Systemic and localized extra-central nervous system bacterial infections and the risk of dementia among US veterans: A retrospective cohort study","volume":"4","author":"Mawanda","year":"2016","journal-title":"Alzheimers Dement."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/20\/3831\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:25:05Z","timestamp":1760189105000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/20\/3831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,11]]},"references-count":20,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2019,10]]}},"alternative-id":["ijerph16203831"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16203831","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,11]]}}}