Cellulitis: Difference between revisions

Revision as of 23:00, 24 March 2021

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
- Acute inflammatory edema
For an exhaustive list, see Cellulitis mimickers

Clinical Manifestations

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.

@@ Line 1: / Line 1: @@
-* Infection of superficial skin and skin structures
+*Infection of superficial skin and skin structures
-== Etiology ==
+==Etiology==
-* ''[[Streptococcus pyogenes]]'' (much more common)
+*''[[Streptococcus pyogenes]]'' (much more common)
-* ''[[Staphylococcus aureus]]'' (especially if purulent)
+*''[[Staphylococcus aureus]]'' (especially if purulent)
-* Rare, depending on exposures:
+*Rare, depending on exposures:
-** Hand or foot puncture: ''[[Pseudomonas aeruginosa]]''
+**Hand or foot puncture: ''[[Pseudomonas aeruginosa]]''
-** Facial cellulitis in children: ''[[Haemophilus influenzae]]''
+**Facial cellulitis in children: ''[[Haemophilus influenzae]]''
-** Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]]
+**Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]]
-** Cat or dog bites: ''[[Pasteurella multocida]]''
+**Cat or dog bites: ''[[Pasteurella multocida]]''
-** Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral)
+**Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral)
-** Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites)
+**Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites)
-** Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
+**Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
-== Differential Diagnosis ==
+==Differential Diagnosis==
-* Skin and soft tissue infections
+*Skin and soft tissue infections
-** Cellulitis (Strep >> Staph)
+**Cellulitis (Strep >> Staph)
-** [[Erysipelas]] (usually Strep)
+**[[Erysipelas]] (usually Strep)
-** [[Abscess]] (usually Staph)
+**[[Abscess]] (usually Staph)
-** Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
+**Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
-** [[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics
+**[[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics
-** Carbuncles
+**Carbuncles
-** [[Necrotizing fasciitis]]
+**[[Necrotizing fasciitis]]
-* Other disease
+*Other disease
-** Deep vein thrombosis
+**[[Deep vein thrombosis]]
-** Gout (if over a joint)
+**[[Gout]] (if over a joint)
-** Erythema nodosum
+**[[Erythema nodosum]]
+**[[Acute inflammatory edema]]
-* For an exhaustive list, see [[Cellulitis mimickers]]
+*For an exhaustive list, see [[Cellulitis mimickers]]
-== Clinical Manifestations ==
+==Clinical Manifestations==
-* Hot, red, swollen, tender area of skin with poorly demarcated margins
+*Hot, red, swollen, tender area of skin with poorly demarcated margins
-* With or without pus and/or bullae
+*With or without pus and/or bullae
-* Legs more common than elsewhere
+*Legs more common than elsewhere
-== Management ==
+==Management==
-* Source control: drain any abscess
+*Source control: drain any abscess
-* Antibiotics for 5-7 days
+*Antibiotics for 5-7 days
-* Purulent SSTI
+*Purulent SSTI
-** Cephalexin or cefazolin are good first-line empiric choices
+**Cephalexin or cefazolin are good first-line empiric choices
-** Doxycycline or vancomycin can also be considered
+**Doxycycline or vancomycin can also be considered
-* Non-purulent SSTI
+*Non-purulent SSTI
-** Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
+**Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
-** If penicillin allergy
+**If penicillin allergy
-*** Clindamycin300mg po qid
+***Clindamycin300mg po qid
-*** Moxifloxacin 400mg po daily
+***Moxifloxacin 400mg po daily
-*** Linezolid 600mg po bid
+***Linezolid 600mg po bid
-*** Clindamycin 600mg IV tid
+***Clindamycin 600mg IV tid
-*** Vancomycin 1g IV q12h
+***Vancomycin 1g IV q12h
-* Non-resolving cellulitis
+*Non-resolving cellulitis
-** Bug-drug mismatch
+**Bug-drug mismatch
-** Resistance
+**Resistance
-** Poor antibiotic choice
+**Poor antibiotic choice
-** Unusual organism
+**Unusual organism
-*** Water exposure (fresh- or saltwater)
+***Water exposure (fresh- or saltwater)
-*** Fish
+***Fish
-*** Shellfish, meats, hides
+***Shellfish, meats, hides
-*** IV drug use
+***IV drug use
-*** Animal or human bites
+***Animal or human bites
-** Poor adherence/absorption/distribution
+**Poor adherence/absorption/distribution
-** Wrong diagnosis
+**Wrong diagnosis
-** Impatience!
+**Impatience!
-* Complications of infection
+*Complications of infection
-** Abscess (drain it)
+**Abscess (drain it)
-** Deep infection
+**Deep infection
-** Metastasis
+**Metastasis
-=== Prophylaxis ===
+===Prophylaxis===
-* May be indicated for patients with recurrent cellulitis
+*May be indicated for patients with recurrent cellulitis
-* Penicillin V 250 mg po bid
+*Penicillin V 250 mg po bid
-* Read more: Oh CC ''et al''. [https://doi.org/10.1016/j.jinf.2014.02.011 Antibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis]. ''J Infect''. 2014;69(1):26-34.
+*Read more: Oh CC ''et al''. [https://doi.org/10.1016/j.jinf.2014.02.011 Antibiotic prophylaxis for preventing recurrent cellulitis: A systematic review and meta-analysis]. ''J Infect''. 2014;69(1):26-34.
 [[Category:Skin and soft tissue infections]]