Cellulitis: Difference between revisions

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== Background ==

*Infection of superficial skin and skin structures
*Infection of superficial skin and skin structures


==Etiology==
===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==

*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
*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
**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 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
***[[Cephalexin]] 500 mg po qid or [[cefazolin]] 1-2 g IV q8h for 5-7 days
**If penicillin allergy
***If penicillin allergy
***Clindamycin300mg po qid
****[[Clindamycin]] 300 mg po qid
***Moxifloxacin 400mg po daily
****[[Moxifloxacin]] 400 mg po daily
***Linezolid 600mg po bid
****[[Linezolid]] 600 mg po bid
***Clindamycin 600mg IV tid
****[[Clindamycin]] 600 mg IV tid
***Vancomycin 1g IV q12h
****[[Vancomycin]] 1 g IV q12h
*Non-resolving cellulitis
*Non-resolving cellulitis
**Bug-drug mismatch
**Bug-drug mismatch

Revision as of 18:02, 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