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
   
==Etiology==
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===Microbiology===
   
 
*''[[Streptococcus pyogenes]]'' (much more common)
 
*''[[Streptococcus pyogenes]]'' (much more common)
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**Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
 
**Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
   
 
==Clinical Manifestations==
==Differential Diagnosis==
 
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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
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== Diagnosis ==
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* Clinical based on typical appearance
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== Differential Diagnosis ==
   
 
*Skin and soft tissue infections
 
*Skin and soft tissue infections
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**[[Acute inflammatory edema]]
 
**[[Acute inflammatory edema]]
 
*For an exhaustive list, see [[Cellulitis mimickers]]
 
*For an exhaustive list, see [[Cellulitis mimickers]]
 
==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
 
   
 
==Management==
 
==Management==
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*Source control: drain any abscess
 
*Source control: drain any abscess
 
*Antibiotics for 5-7 days
 
*Antibiotics for 5-7 days
*Purulent SSTI
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**Purulent SSTI
**Cephalexin or cefazolin are good first-line empiric choices
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***[[Cephalexin]] or [[cefazolin]] are good first-line empiric choices
**Doxycycline or vancomycin can also be considered
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***Doxycycline or vancomycin can also be considered
*Non-purulent SSTI
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**Non-purulent SSTI
**Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
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***[[Cephalexin]] 500 mg po qid or [[cefazolin]] 1-2 g IV q8h for 5-7 days
**If penicillin allergy
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***If penicillin allergy
***Clindamycin300mg po qid
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****[[Clindamycin]] 300 mg po qid
***Moxifloxacin 400mg po daily
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****[[Moxifloxacin]] 400 mg po daily
***Linezolid 600mg po bid
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****[[Linezolid]] 600 mg po bid
***Clindamycin 600mg IV tid
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****[[Clindamycin]] 600 mg IV tid
***Vancomycin 1g IV q12h
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****[[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

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

Management

  • Source control: drain any abscess
  • Antibiotics for 5-7 days
  • 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