Cellulitis: Difference between revisions
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− | * |
+ | *Infection of superficial skin and skin structures |
− | == |
+ | ==Etiology== |
− | * |
+ | *''[[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) |
− | == |
+ | ==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]] |
− | == |
+ | ==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== |
− | * |
+ | *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 |
− | ** |
+ | **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''. [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]] |
Revision as of 19:00, 24 March 2021
- Infection of superficial skin and skin structures
Etiology
- 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)
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
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
- 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
- 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.