Cellulitis: Difference between revisions
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| + | == Background == |
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| − | * Infection of superficial skin and skin structures |
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| + | *Infection of superficial skin and skin structures |
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| − | = Etiology = |
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| + | ===Microbiology=== |
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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]]'' |
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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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| + | *''[[Streptococcus pyogenes]]'' (much more common) |
||
| − | = Differential Diagnosis = |
||
| + | *''[[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== |
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| − | * Skin and soft tissue infections |
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| − | ** Cellulitis (Strep/Staph) |
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| − | ** 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) |
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| − | ** Erythema nodosum |
||
| − | * For an exhaustive list, see [Cellulitis mimickers](Cellulitis mimickers.md) |
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| + | *Hot, red, swollen, tender area of skin with poorly demarcated margins |
||
| − | = Presentation = |
||
| + | *With or without pus and/or bullae |
||
| + | *Legs more common than elsewhere |
||
| + | == Diagnosis == |
||
| − | * Hot, red, swollen, tender area of skin with poorly demarcated margins |
||
| − | * With or without pus and/or bullae |
||
| − | * Legs more common than elsewhere |
||
| + | * Clinical based on typical appearance |
||
| − | = Management = |
||
| + | == Differential Diagnosis == |
||
| − | * 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 |
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| − | ** Resistance |
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| − | ** Poor antibiotic choice |
||
| − | ** Unusual organism |
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| − | *** Water exposure (fresh- or saltwater) |
||
| − | *** Fish |
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| − | *** 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 |
||
| + | *Skin and soft tissue infections |
||
| − | == Prophylaxis == |
||
| + | **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== |
||
| − | * May be indicated for patients with recurrent cellulitis |
||
| + | |||
| − | * Penicillin V 250 mg po bid |
||
| + | *Source control: drain any abscess |
||
| − | * 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. |
||
| + | *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 |
||
| + | *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 bites|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''. [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]] |
[[Category:Skin and soft tissue infections]] |
||
Latest revision as of 13:46, 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.
