23 - 151 - CELLULITIS AND ERYSIPELAS Flashcards
sharply demarcated, bright red, edematous plaques resulting from superficial lymphatic infiltration
ERYSIPELAS
common infection of the deep dermis and subcutaneous tissue, most often caused by bacteria, that presents with the classic signs of inflammation
Cellulitis
presence of pustules or abscess development, which may precede or follow cellulitis
Purulent cellulitis
Most common causes of cellulitis and erysipelas
GAS and S. Aureus
Most common causes of cellulitis from animal and human bites
Pasteurella spp.
Streptococci
Staphylococci
Most common causes of cellulitis from aquatic trauma
- aeromonas spp.
- Erysipelothrix rhusiopathiae
- Mycobacterium marinum and other atypical mycobacteria;
- Vibrio vulnificus
Systemic and Local Risk Factors for Primary and Recurrent Cellulitis
Highest risk factor for cellulitis
Lymphedema (> 70-fold), followed by disruption skin barrier (24-fold)
ALT-70 Risk Prediction for Cellulitis
A skin surface temperature gradient greater than ________ between a patient’s involved and uninvolved skin, as determined by thermal imaging, has also shown promise, with a sensitivity of 96.6% for the diagnosis of cellulitis
0.47°C (0.85°F)
most common cause of pseudocellulitis
Stasis dermatitis
systemic inflammatory response syndrome criteria
- (temperature >38°C [100.4°F] or <36°C [96.8°F];
- pulse >90 beats/min;
- respiratory rate >20 breaths/min; or
- leukocyte count >12,000 cells/µL or <4000 cells/µL)
first-line agents of choice in MSSA
Cephalexin and dicloxacillin
First-line agents for MRSA
clindamycin, tetracyclines, and trimethoprim-sulfamethoxazole
If penicillin or cephalosporin allergy exists, what can we give?
Clindamycin
In patients with purulent cellullitis with systemic infection or failure of outpatient treatment, what parenteral antibiotics are appropriate for MSSA?
Oxacillin, nafcillin, and cefazolin,
In patients with purulent cellullitis with systemic infection or failure of outpatient treatment, what parenteral antibiotics are appropriate for MRSA?
Vancomycin, clindamycin, or linezolid
Indications for Parenteral Administration of Antibiotics
most common site of cellulitis in adults
lower extremities
cellulitis affects what part of the skin
deep dermis and subcutaneous tissue
Erysipelas is a variant of cellulitis that predominantly affects what?
superficial lymphatic vessels and surrounding tissue
cellulitis affecting the face is more common in what population?
children
a frequent complication of cellulitis that increases the risk of recurrence
Lymphatic damage leading to lymphedema
When there is significant involvement of the lymphatics or superficial edema, the skin may acquire a peau d’orange appearance.
Cellulitis
MC site of involvement of erysipelas
leg
followed by the face and upper extremity
A skin surface temperature gradient greater than what temperature (0.85°F) between a patient’s involved and uninvolved skin, as determined by thermal imaging, has also shown promise, with a sensitivity of 96.6% for the diagnosis of cellulitis, but additional confirmatory studies are needed
0.47°C
Nonpurulent cellulitis without systemic evidence of infection should be treated with what oral medications?
oral antistreptococcal antibiotics such as cephalexin, dicloxacillin, or penicillin V
In cases of true Type I hypersensitivity reactions to penicillins or cephalosporins, in patients with nonpurulent cellulitis without systemic evidence of infection, what alternative medications should be considered?
clindamycin or macrolides
Patients with nonpurulent cellulitis WITH evidence of systemic infection, including 2 or more systemic inflammatory response syndrome criteria or those who fail outpatient treatment whould receive parenteral antibiotics such as?
cefazolin, ceftriaxone, or penicillin G
If there is associated penetrating trauma in moderate nonpurulent cellulitis, including injection drug use, or known MRSA colonization or infection elsewhere, empiric coverage with what drug?
vancomycin
