Cellulitis: Difference between revisions
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= Etiology = |
= Etiology = |
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* ''Streptococcus pyogenes'' (much more common) |
* ''[[Streptococcus pyogenes]]'' (much more common) |
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* ''Staphylococcus aureus'' (especially if purulent) |
* ''[[Staphylococcus aureus]]'' (especially if purulent) |
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* Rare, depending on exposures: |
* Rare, depending on exposures: |
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** Hand or foot puncture: ''Pseudomonas aeruginosa'' |
** Hand or foot puncture: ''[[Pseudomonas aeruginosa]]'' |
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** Facial cellulitis in children: ''Haemophilus influenzae'' |
** Facial cellulitis in children: ''[[Haemophilus influenzae]]'' |
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** Human bite wounds: Anaerobes, ''Eikenella'', viridans-group |
** Human bite wounds: Anaerobes, ''[[Eikenella]]'', [[viridans-group Streptococci]] |
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** Cat or dog bites: ''Pasteurella multocida'' |
** Cat or dog bites: ''[[Pasteurella multocida]]'' |
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** Saltwater exposure: ''Vibrio vulnificus'' (e.g. injury on coral) |
** Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral) |
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** Fresh- or saltwater exposure: ''Aeromonas hydrophila'' (e.g. leech bites) |
** Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites) |
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** Butchers: ''Erysipelothrix'' (erysipeloid) |
** Butchers: ''[[Erysipelothrix]]'' (erysipeloid) |
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= Differential Diagnosis = |
= Differential Diagnosis = |
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Revision as of 03:52, 15 August 2019
- Infection of superficial skin and skin structures
Etiology
- Streptococcus pyogenes (much more common)
- Staphylococcus aureus (especially if purulent)
- Rare, depending on exposures:
- Hand or foot puncture: Pseudomonas aeruginosa
- Facial cellulitis in children: Haemophilus influenzae
- Human bite wounds: Anaerobes, Eikenella, viridans-group Streptococci
- Cat or dog bites: Pasteurella multocida
- Saltwater exposure: Vibrio vulnificus (e.g. injury on coral)
- Fresh- or saltwater exposure: Aeromonas hydrophila (e.g. leech bites)
- Butchers: Erysipelothrix (erysipeloid)
Differential Diagnosis
- Skin and soft tissue infections
- Cellulitis (Strep/Staph)
- Erysipelas (usually Strep)
- Abscess (usually Staph)
- Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
- Impetigo (usually Staph): watchful waiting, or topical or systemic antibiotics
- Carbuncles
- Necrotizing fasciitis
- Other disease
- Deep vein thrombosis
- Gout (if over a joint)
- Erythema nodosum
- For an exhaustive list, see [Cellulitis mimickers](Cellulitis mimickers.md)
Presentation
- Hot, red, swollen, tender area of skin with poorly demarcated margins
- With or without pus and/or bullae
- Legs more common than elsewhere
Management
- Source control: drain any abscess
- Antibiotics for 5-7 days
- Purulent SSTI
- Cephalexin or cefazolin are good first-line empiric choices
- Doxycycline or vancomycin can also be considered
- Non-purulent SSTI
- Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
- If penicillin allergy
- Clindamycin300mg po qid
- Moxifloxacin 400mg po daily
- Linezolid 600mg po bid
- Clindamycin 600mg IV tid
- Vancomycin 1g IV q12h
- Non-resolving cellulitis
- Bug-drug mismatch
- Resistance
- Poor antibiotic choice
- Unusual organism
- Water exposure (fresh- or saltwater)
- Fish
- Shellfish, meats, hides
- IV drug use
- Animal or human bites
- Poor adherence/absorption/distribution
- Wrong diagnosis
- Impatience!
- Complications of infection
- Abscess (drain it)
- Deep infection
- Metastasis
Prophylaxis
- May be indicated for patients with recurrent cellulitis
- Penicillin V 250 mg po bid
- Read more: Oh CC et al. Antibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis. J Infect. 2014;69(1):26-34.
