Cellulitis: Difference between revisions
From IDWiki
(→) |
(→) |
||
Line 1: | Line 1: | ||
+ | == Background == |
||
+ | |||
*Infection of superficial skin and skin structures |
*Infection of superficial skin and skin structures |
||
− | == |
+ | ===Microbiology=== |
*''[[Streptococcus pyogenes]]'' (much more common) |
*''[[Streptococcus pyogenes]]'' (much more common) |
||
Line 14: | Line 16: | ||
**Butchers: ''[[Erysipelothrix]]'' (erysipeloid) |
**Butchers: ''[[Erysipelothrix]]'' (erysipeloid) |
||
⚫ | |||
⚫ | |||
+ | |||
⚫ | |||
⚫ | |||
⚫ | |||
+ | |||
+ | == Diagnosis == |
||
+ | |||
+ | * Clinical based on typical appearance |
||
+ | |||
⚫ | |||
*Skin and soft tissue infections |
*Skin and soft tissue infections |
||
Line 30: | Line 42: | ||
**[[Acute inflammatory edema]] |
**[[Acute inflammatory edema]] |
||
*For an exhaustive list, see [[Cellulitis mimickers]] |
*For an exhaustive list, see [[Cellulitis mimickers]] |
||
− | |||
⚫ | |||
− | |||
⚫ | |||
⚫ | |||
⚫ | |||
==Management== |
==Management== |
||
Line 41: | Line 47: | ||
*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 |
+ | ***[[Cephalexin]] 500 mg po qid or [[cefazolin]] 1-2 g IV q8h for 5-7 days |
− | **If penicillin allergy |
+ | ***If penicillin allergy |
− | *** |
+ | ****[[Clindamycin]] 300 mg po qid |
− | ***Moxifloxacin |
+ | ****[[Moxifloxacin]] 400 mg po daily |
− | ***Linezolid |
+ | ****[[Linezolid]] 600 mg po bid |
− | ***Clindamycin |
+ | ****[[Clindamycin]] 600 mg IV tid |
− | ***Vancomycin |
+ | ****[[Vancomycin]] 1 g IV q12h |
*Non-resolving cellulitis |
*Non-resolving cellulitis |
||
**Bug-drug mismatch |
**Bug-drug mismatch |
Revision as of 14:02, 28 March 2021
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.