Cellulitis: Difference between revisions

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


== Etiology ==
==Etiology==


* ''[[Streptococcus pyogenes]]'' (much more common)
*''[[Streptococcus pyogenes]]'' (much more common)
* ''[[Staphylococcus aureus]]'' (especially if purulent)
*''[[Staphylococcus aureus]]'' (especially if purulent)
* Rare, depending on exposures:
*Rare, depending on exposures:
** Hand or foot puncture: ''[[Pseudomonas aeruginosa]]''
**Hand or foot puncture: ''[[Pseudomonas aeruginosa]]''
** Facial cellulitis in children: ''[[Haemophilus influenzae]]''
**Facial cellulitis in children: ''[[Haemophilus influenzae]]''
** Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]]
**Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]]
** Cat or dog bites: ''[[Pasteurella multocida]]''
**Cat or dog bites: ''[[Pasteurella multocida]]''
** Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral)
**Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral)
** Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites)
**Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites)
** Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
**Butchers: ''[[Erysipelothrix]]'' (erysipeloid)


== Differential Diagnosis ==
==Differential Diagnosis==


* Skin and soft tissue infections
*Skin and soft tissue infections
** Cellulitis (Strep >> Staph)
**Cellulitis (Strep >> Staph)
** [[Erysipelas]] (usually Strep)
**[[Erysipelas]] (usually Strep)
** [[Abscess]] (usually Staph)
**[[Abscess]] (usually Staph)
** Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
**Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
** [[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics
**[[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics
** Carbuncles
**Carbuncles
** [[Necrotizing fasciitis]]
**[[Necrotizing fasciitis]]
* Other disease
*Other disease
** Deep vein thrombosis
**[[Deep vein thrombosis]]
** Gout (if over a joint)
**[[Gout]] (if over a joint)
** Erythema nodosum
**[[Erythema nodosum]]
**[[Acute inflammatory edema]]
* For an exhaustive list, see [[Cellulitis mimickers]]
*For an exhaustive list, see [[Cellulitis mimickers]]


== Clinical Manifestations ==
==Clinical Manifestations==


* Hot, red, swollen, tender area of skin with poorly demarcated margins
*Hot, red, swollen, tender area of skin with poorly demarcated margins
* With or without pus and/or bullae
*With or without pus and/or bullae
* Legs more common than elsewhere
*Legs more common than elsewhere


== Management ==
==Management==


* 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 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
** If penicillin allergy
**If penicillin allergy
*** Clindamycin300mg po qid
***Clindamycin300mg po qid
*** Moxifloxacin 400mg po daily
***Moxifloxacin 400mg po daily
*** Linezolid 600mg po bid
***Linezolid 600mg po bid
*** Clindamycin 600mg IV tid
***Clindamycin 600mg IV tid
*** Vancomycin 1g IV q12h
***Vancomycin 1g IV q12h
* Non-resolving cellulitis
*Non-resolving cellulitis
** Bug-drug mismatch
**Bug-drug mismatch
** Resistance
**Resistance
** Poor antibiotic choice
**Poor antibiotic choice
** Unusual organism
**Unusual organism
*** Water exposure (fresh- or saltwater)
***Water exposure (fresh- or saltwater)
*** Fish
***Fish
*** Shellfish, meats, hides
***Shellfish, meats, hides
*** IV drug use
***IV drug use
*** Animal or human bites
***Animal or human bites
** Poor adherence/absorption/distribution
**Poor adherence/absorption/distribution
** Wrong diagnosis
**Wrong diagnosis
** Impatience!
**Impatience!
* Complications of infection
*Complications of infection
** Abscess (drain it)
**Abscess (drain it)
** Deep infection
**Deep infection
** Metastasis
**Metastasis


=== Prophylaxis ===
===Prophylaxis===


* May be indicated for patients with recurrent cellulitis
*May be indicated for patients with recurrent cellulitis
* Penicillin V 250 mg po bid
*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.
*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 23:00, 24 March 2021

  • Infection of superficial skin and skin structures

Etiology

Differential Diagnosis

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