Cellulitis resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Synonyms and keywords:

Causes

Life Threatening Causes

No known life-threatening causes are included.

Common Causes

The cellulitis is bacterial in origin caused by invasion of bacteria through the skin barrier. The common causes are:

• Streptococcus pyogenes
• Staphylococcus aureus
• Haemophilus influenza type B
• Clostridium
• Streptococcus pneumoniae
• Neisseria meningitidis

Diagnosis

Shown below is an algorithm summarizing the diagnosis of cellulitis according to the Infectious Diseases Society of America guidelines.

Patients presents with clinical symptoms suggestive of cellulitis, i.e. erythema edema warmth swollen regional lymph nodes involvement of one limb.

Perform compression Doppler ultrasound of the limb and D-dimers level

Positive

Negative

likely Deep venous thrombosis (DVT)

DVT unlikely. High clinical suspicion for cellulitis

Assess levels of inflammatory markers

Raised ESR, CRP and leukocytosis

Does patient have any signs of rapidly progressive or systemic infection? Body temperature>101.5 degrees Fahrenheit, chills, headache, and fatigue Signs of sepsis. i.e. hypotension and heart rate>100bpm Patient develops rapidly progressive symptoms like bullae, vesicles, petechiae, crepitus Patient has low immunity (i.e. infants and elderly patients)

Perform the following tests: Debridement of wound with culture of the specimen Blood culture Radiographic tests to evaluate deep tissue infection

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Is the cellulitis having a purulent discharge?

Yes

No

Are there any of the following clinical signs? Systemic toxicity (fever, hypotension, and tachycardia) Presence of an indwelling device (pacemaker, vascular graft) Patient is on extremes of age Major comorbid conditions

Yes

No

Initiate intravenous antibiotic therapy. The coverage of the micro-organisms is determined by: Oral or peri-rectal ulcers Pressure ulcer with draining abscess Necrosis of overlying skin

Initiate oral antibiotic therapy. The coverage of the micro-organisms is determined by: Oral or peri-rectal ulcers Pressure ulcer with draining abscess Necrosis of overlying skin

Yes

No

Yes

No

No

Initiate antibiotics that cover both MRSA and gram negative rods. To cover MRSA: Vancomycin or Daptomycin Plus one of the following to cover for gram negative rods Ampicillin-Sulbactam Piperacillin-Tazobactam Ceftriaxone plus metronidazole Levofloxacin plus metronidazole

Infection most likely due to MRSA. Initiate Vancomycin or Daptomycin

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.