Cellulitis: Difference between revisions
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== Background == |
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*Infection of superficial skin and skin structures |
*Infection of superficial skin and skin structures |
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===Microbiology=== |
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*''[[Streptococcus pyogenes]]'' (much more common) |
*''[[Streptococcus pyogenes]]'' (much more common) |
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**Butchers: ''[[Erysipelothrix]]'' (erysipeloid) |
**Butchers: ''[[Erysipelothrix]]'' (erysipeloid) |
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== Diagnosis == |
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* Clinical based on typical appearance |
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*Skin and soft tissue infections |
*Skin and soft tissue infections |
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**[[Acute inflammatory edema]] |
**[[Acute inflammatory edema]] |
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*For an exhaustive list, see [[Cellulitis mimickers]] |
*For an exhaustive list, see [[Cellulitis mimickers]] |
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==Management== |
==Management== |
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*Source control: drain any abscess |
*Source control: drain any abscess |
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*Antibiotics for 5-7 days |
*Antibiotics for 5-7 days |
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*Purulent SSTI |
**Purulent SSTI |
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**Cephalexin or cefazolin are good first-line empiric choices |
***[[Cephalexin]] or [[cefazolin]] are good first-line empiric choices |
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**Doxycycline or vancomycin can also be considered |
***Doxycycline or vancomycin can also be considered |
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*Non-purulent SSTI |
**Non-purulent SSTI |
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**Cephalexin |
***[[Cephalexin]] 500 mg po qid or [[cefazolin]] 1-2 g IV q8h for 5-7 days |
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**If penicillin allergy |
***If penicillin allergy |
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*** |
****[[Clindamycin]] 300 mg po qid |
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***Moxifloxacin |
****[[Moxifloxacin]] 400 mg po daily |
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***Linezolid |
****[[Linezolid]] 600 mg po bid |
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***Clindamycin |
****[[Clindamycin]] 600 mg IV tid |
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***Vancomycin |
****[[Vancomycin]] 1 g IV q12h |
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*Non-resolving cellulitis |
*Non-resolving cellulitis |
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**Bug-drug mismatch |
**Bug-drug mismatch |
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***Shellfish, meats, hides |
***Shellfish, meats, hides |
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***IV drug use |
***IV drug use |
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***Animal or human bites |
***[[Animal bites|Animal or human bites]] |
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**Poor adherence/absorption/distribution |
**Poor adherence/absorption/distribution |
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**Wrong diagnosis |
**Wrong diagnosis |
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**Impatience! |
**Impatience! |
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*Complications of infection |
*Complications of infection |
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**Abscess (drain it) |
**[[Abscess]] (drain it) |
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**Deep infection |
**Deep infection |
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**Metastasis |
**Metastasis |
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*May be indicated for patients with recurrent cellulitis |
*May be indicated for patients with recurrent cellulitis |
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*Penicillin V 250 mg po bid |
*[[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. |
*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.
