Cellulitis: Difference between revisions
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== Background == |
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*Infection of superficial skin and skin structures |
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== Definition == |
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===Microbiology=== |
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* Infection of superficial skin and soft tissue |
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*''[[Streptococcus pyogenes]]'' (much more common) |
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== Etiology == |
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*''[[Staphylococcus aureus]]'' (especially if purulent) |
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*Rare, depending on exposures: |
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**Hand or foot puncture: ''[[Pseudomonas aeruginosa]]'' |
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**Facial cellulitis in children: ''[[Haemophilus influenzae]]'' |
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**Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]] |
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**Cat or dog bites: ''[[Pasteurella multocida]]'' |
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**Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral) |
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**Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites) |
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**Butchers: ''[[Erysipelothrix]]'' (erysipeloid) |
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==Clinical Manifestations== |
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* ''Streptococcus pyogenes'' (much more common) |
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* ''Staphylococcus aureus'' (especially if purulent) |
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* Rare, depending on exposures: |
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** Hand or foot puncture: ''Pseudomonas aeruginosa'' |
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** Facial cellulitis in children: ''Haemophilus influenzae'' |
|||
** Human bite wounds: Anaerobes, ''Eikenella'', viridans-group ''Streptococcus'' |
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** Cat or dog bites: ''Pasteurella multocida'' |
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** Saltwater exposure: ''Vibrio vulnificus'' (e.g. injury on coral) |
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** Fresh- or saltwater exposure: ''Aeromonas hydrophila'' (e.g. leech bites) |
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** Butchers: ''Erysipelothrix'' (erysipeloid) |
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*Hot, red, swollen, tender area of skin with poorly demarcated margins |
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== Differential Diagnosis == |
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*With or without pus and/or bullae |
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*Legs more common than elsewhere |
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== Diagnosis == |
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* Skin and soft tissue infections |
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** Cellulitis (Strep/Staph) |
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* Clinical based on typical appearance |
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** Erysipelas (usually Strep) |
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** Abscess (usually Staph) |
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== Differential Diagnosis == |
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** Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment |
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** Impetigo (usually Staph): watchful waiting, or topical or systemic antibiotics |
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** Carbuncles |
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** Necrotizing fasciitis |
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* Other disease |
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** Deep vein thrombosis |
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** Gout (if over a joint) |
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** Erythema nodosum |
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* For an exhaustive list, see [Cellulitis mimickers](Cellulitis mimickers.md) |
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*Skin and soft tissue infections |
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== Presentation == |
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**Cellulitis (Strep >> Staph) |
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**[[Erysipelas]] (usually Strep) |
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**[[Abscess]] (usually Staph) |
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**Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment |
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**[[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics |
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**Carbuncles |
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**[[Necrotizing fasciitis]] |
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*Other disease |
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**[[Deep vein thrombosis]] |
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**[[Gout]] (if over a joint) |
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**[[Erythema nodosum]] |
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**[[Acute inflammatory edema]] |
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*For an exhaustive list, see [[Cellulitis mimickers]] |
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==Management== |
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* Hot, red, swollen, tender area of skin with poorly demarcated margins |
|||
* With or without pus and/or bullae |
|||
* Legs more common than elsewhere |
|||
*Source control: drain any abscess |
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== Management == |
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*Antibiotics for 5-7 days |
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**Purulent SSTI |
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***[[Cephalexin]] or [[cefazolin]] are good first-line empiric choices |
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***Doxycycline or vancomycin can also be considered |
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**Non-purulent SSTI |
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***[[Cephalexin]] 500 mg po qid or [[cefazolin]] 1-2 g IV q8h for 5-7 days |
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***If penicillin allergy |
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****[[Clindamycin]] 300 mg po qid |
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****[[Moxifloxacin]] 400 mg po daily |
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****[[Linezolid]] 600 mg po bid |
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****[[Clindamycin]] 600 mg IV tid |
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****[[Vancomycin]] 1 g IV q12h |
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*Non-resolving cellulitis |
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**Bug-drug mismatch |
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**Resistance |
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**Poor antibiotic choice |
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**Unusual organism |
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***Water exposure (fresh- or saltwater) |
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***Fish |
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***Shellfish, meats, hides |
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***IV drug use |
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***[[Animal bites|Animal or human bites]] |
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**Poor adherence/absorption/distribution |
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**Wrong diagnosis |
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**Impatience! |
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*Complications of infection |
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**[[Abscess]] (drain it) |
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**Deep infection |
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**Metastasis |
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===Prophylaxis=== |
|||
* 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 |
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** Metastasis |
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*May be indicated for patients with recurrent cellulitis |
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=== Prophylaxis === |
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*[[Penicillin V]] 250 mg po bid |
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*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. |
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[[Category:Skin and soft tissue infections]] |
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* May be indicated for patients with recurrent cellulitis |
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* Penicillin V 250 mg po bid |
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* 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. |
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Latest revision as of 17:46, 14 July 2022
Background
- Infection of superficial skin and skin structures
Microbiology
- 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)
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
Diagnosis
- Clinical based on typical appearance
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
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 500 mg po qid or cefazolin 1-2 g IV q8h for 5-7 days
- If penicillin allergy
- Clindamycin 300 mg po qid
- Moxifloxacin 400 mg po daily
- Linezolid 600 mg po bid
- Clindamycin 600 mg IV tid
- Vancomycin 1 g IV q12h
- Purulent SSTI
- 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.
