Cellulitis: Difference between revisions
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+ | == Background == |
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− | == Etiology == |
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+ | ===Microbiology=== |
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+ | ==Clinical Manifestations== |
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− | == Presentation == |
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+ | == Diagnosis == |
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+ | * Clinical based on typical appearance |
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+ | **[[Acute inflammatory edema]] |
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− | == |
+ | ==Management== |
− | * |
+ | *Source control: drain any abscess |
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+ | *Antibiotics for 5-7 days |
− | * |
+ | **Purulent SSTI |
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+ | ***[[Cephalexin]] or [[cefazolin]] are good first-line empiric choices |
− | ** |
+ | ***Doxycycline or vancomycin can also be considered |
− | * |
+ | **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 |
− | ** |
+ | **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 |
− | *** Animal or human bites |
+ | ***[[Animal bites|Animal or human bites]] |
− | ** |
+ | **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 |
− | === |
+ | ===Prophylaxis=== |
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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. |
[[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.