Cellulitis: Difference between revisions

From IDWiki
m (Text replacement - "== Presentation" to "== Clinical Manifestations")
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* Infection of superficial skin and skin structures
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*Infection of superficial skin and skin structures
   
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== Etiology ==
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==Etiology==
   
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* ''[[Streptococcus pyogenes]]'' (much more common)
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*''[[Streptococcus pyogenes]]'' (much more common)
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* ''[[Staphylococcus aureus]]'' (especially if purulent)
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*''[[Staphylococcus aureus]]'' (especially if purulent)
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* Rare, depending on exposures:
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*Rare, depending on exposures:
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** Hand or foot puncture: ''[[Pseudomonas aeruginosa]]''
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**Hand or foot puncture: ''[[Pseudomonas aeruginosa]]''
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** Facial cellulitis in children: ''[[Haemophilus influenzae]]''
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**Facial cellulitis in children: ''[[Haemophilus influenzae]]''
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** Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]]
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**Human bite wounds: [[anaerobes]], ''[[Eikenella]]'', [[Viridans group streptococci]]
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** Cat or dog bites: ''[[Pasteurella multocida]]''
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**Cat or dog bites: ''[[Pasteurella multocida]]''
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** Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral)
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**Saltwater exposure: ''[[Vibrio vulnificus]]'' (e.g. injury on coral)
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** Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites)
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**Fresh- or saltwater exposure: ''[[Aeromonas hydrophila]]'' (e.g. leech bites)
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** Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
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**Butchers: ''[[Erysipelothrix]]'' (erysipeloid)
   
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== Differential Diagnosis ==
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==Differential Diagnosis==
   
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* Skin and soft tissue infections
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*Skin and soft tissue infections
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** Cellulitis (Strep >> Staph)
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**Cellulitis (Strep >> Staph)
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** [[Erysipelas]] (usually Strep)
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**[[Erysipelas]] (usually Strep)
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** [[Abscess]] (usually Staph)
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**[[Abscess]] (usually Staph)
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** Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
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**Folliculitis (usually Staph or Pseudomonas): warm compresses and mupirocin ointment
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** [[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics
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**[[Impetigo]] (usually Staph): watchful waiting, or topical or systemic antibiotics
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** Carbuncles
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**Carbuncles
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** [[Necrotizing fasciitis]]
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**[[Necrotizing fasciitis]]
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* Other disease
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*Other disease
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** Deep vein thrombosis
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**[[Deep vein thrombosis]]
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** Gout (if over a joint)
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**[[Gout]] (if over a joint)
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** Erythema nodosum
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**[[Erythema nodosum]]
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**[[Acute inflammatory edema]]
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* For an exhaustive list, see [[Cellulitis mimickers]]
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*For an exhaustive list, see [[Cellulitis mimickers]]
   
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== Clinical Manifestations ==
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==Clinical Manifestations==
   
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* Hot, red, swollen, tender area of skin with poorly demarcated margins
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*Hot, red, swollen, tender area of skin with poorly demarcated margins
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* With or without pus and/or bullae
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*With or without pus and/or bullae
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* Legs more common than elsewhere
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*Legs more common than elsewhere
   
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== Management ==
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==Management==
   
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* Source control: drain any abscess
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*Source control: drain any abscess
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* Antibiotics for 5-7 days
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*Antibiotics for 5-7 days
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* Purulent SSTI
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*Purulent SSTI
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** Cephalexin or cefazolin are good first-line empiric choices
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**Cephalexin or cefazolin are good first-line empiric choices
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** Doxycycline or vancomycin can also be considered
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**Doxycycline or vancomycin can also be considered
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* Non-purulent SSTI
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*Non-purulent SSTI
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** Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
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**Cephalexin 500mg po qid or cefazolin 1-2g IV q8h for 5-7 days
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** If penicillin allergy
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**If penicillin allergy
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*** Clindamycin300mg po qid
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***Clindamycin300mg po qid
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*** Moxifloxacin 400mg po daily
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***Moxifloxacin 400mg po daily
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*** Linezolid 600mg po bid
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***Linezolid 600mg po bid
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*** Clindamycin 600mg IV tid
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***Clindamycin 600mg IV tid
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*** Vancomycin 1g IV q12h
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***Vancomycin 1g IV q12h
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* Non-resolving cellulitis
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*Non-resolving cellulitis
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** Bug-drug mismatch
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**Bug-drug mismatch
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** Resistance
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**Resistance
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** Poor antibiotic choice
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**Poor antibiotic choice
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** Unusual organism
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**Unusual organism
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*** Water exposure (fresh- or saltwater)
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***Water exposure (fresh- or saltwater)
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*** Fish
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***Fish
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*** Shellfish, meats, hides
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***Shellfish, meats, hides
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*** IV drug use
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***IV drug use
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*** Animal or human bites
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***Animal or human bites
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** Poor adherence/absorption/distribution
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**Poor adherence/absorption/distribution
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** Wrong diagnosis
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**Wrong diagnosis
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** Impatience!
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**Impatience!
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* Complications of infection
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*Complications of infection
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** Abscess (drain it)
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**Abscess (drain it)
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** Deep infection
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**Deep infection
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** Metastasis
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**Metastasis
   
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=== Prophylaxis ===
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===Prophylaxis===
   
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* May be indicated for patients with recurrent cellulitis
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*May be indicated for patients with recurrent cellulitis
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* Penicillin V 250 mg po bid
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*Penicillin V 250 mg po bid
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* 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.
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*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

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

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