Cellulitis Flashcards
Cellulitis risk factors:
immune suppression
breaches in skin barrier (trauma to skin)
chronic edema
obesity
tinea pedis
lymphedema
vascular disease
what are some examples of immune suppressed states that are at increased risk for cellulitis?
DM2
HIV
chronic steroid therapy
what are some examples of breaches in skin that are at increased risk for cellulitis?
dry skin chronic inflammation (eczema, radiation therapy)
chronic wounds (pressure ulcer, venous ulcer)
dermatophyte infection (tinea pedis)
what kind of chronic edema that can cause cellulitis:
post surgical lymphedema (lymph node dissection)
chronic venous insufficiency
CHF and CKD
prior cellulitis with lymphatic scarring
Tinea pedis can cause
skin breakdown between dose and cause a site for bacterial entry in small area. This can cause cellulitis.
Reoccurrence of cellulitis
happens up to 30% in pts due to skin barrier breakdown or lymphatic stasis.
clinical features of cellulitis:
increasing pain, swelling fever, lymphangitis, regional adenopathy and see erythema of skin and purulence
mild superficial infections like impetigo can be treated with
topical mupirocin
systemic abx for cellulitis are needed when:
extensive cellulitis >2 cm from wound margin or infection of deep tissue
moderate cellulitis treatment should have abx that
cover staph and strep species.
moderate cellulitis treatment with purulence or pustules should have abx that have:
that cover for staph
clindamycin
bactrim
moderate cellulitis treatment WITHOUT purulence or pustules should have abx that have:
Cellulitis without purulence THINK Strep
should be treated with : clindamycin, dicloxacillin or cephlexin
moderate infection with bite wounds should get abx with
anerobic coverage (amoxicillin/clavulanate)
immunocompromised pts with severe wound infections (high fever, HD instability) need to
get hospitalized and IV abx.
does hydrogen peroxide have a role in wound healing?
Can be used for initial wound management to remove dried blood and necrotic tissue _but ineffective in treating established wound infectio_ns and doesn’t promote healing.
wet to dry gauzes are used for
debridement in wounds with extensive exudate
Bite wound treatment
Treat all wounds with irrigation with sterile normal saline - allows for better characterization of wound and signs of inflmmation and infection.
May need XR to look for fracture, other boney involvement, or foreign bodies.
Assessment for tetanus and rabies prophylaxis is essential.
Primary wound closure is not needed unless for facial wounds.
3-5 day course of augmentin (amoxicillin -clavulanate) is needed for immunosuppressed, cirrhosis and asplenia.
Capnocytophagia canimorsus common part of canine microbiota and can cause severe infections with asplenia.
Pt gets bitten by cat. why are cat bites bad?
how to prevent complications?
cat bites have deep puncture wounds to hands and can be deep. infections when hear extremiteis can progress to bone or joint infections and so antibiotic prophylaxis can help reduce infection rates
when to give antibiotic prophylaxis (doxycycline and metronidazole) after cat bite?
recommended for animal bite wound near lymphatics and blood vessels, on hand and close to joints or bones, AND IN IMMUNOCOMPROMISED PTS AND THOSE THAT NEED SURGERY.
antibiotic prophylaxis can help reduce infection rates
What bacteria are seen with cat bites?
What antibiotics are appropriate for antibiotic prophylaxis?
pasturella multicida and streptococcus and other anaerobic bacteria.
Cover infection with amoxicillin/clavulanate for porphylaxis and alternate for penicillin allergy is doxycyline/metronidazole.
Give for 3-5 days and some people give first dose IV then followed by oral
Can use doxycycline or bactrim for those that are at risk for MRSA infections.
how to manage a cat bite?
wash wound (irrigate) and have debris removal and should be left open to heal by secondary intention rather than primary closure.
Give antibiotic prophylaxis.
Needs careful follow up for deeper wound infection that may require extended antibiotic therapy. primary closure can be done at hte time if no signs of infeciton. non healing wounds need surgical debridement.
SHould also get a tetanus booster and be considered for rabies vaccine.
other considerations after a cat bite?
Should also get a tetanus booster and be considered for rabies vaccine.
when to give tetanus immunoglobulin after a cat bite?
high risk bites who have not been recently immunized <5 yrs
skin abscess need to have I and D but when should you add antibiotic treatment
abscess >2 cm
extensive surrounding cellulitis
systemic symptoms of infection (fever, chills, tachycardia and WBC)
neutropenia
multiple abscesses
extremes of age
lack of response to I&D
What antibiotics should be given for abscess?
bactrim or doxycyline is generally curative
IV antibiotics should be given in those with systemic symptoms or rapidly progressive symptoms or persistent symptoms after 48 hrs of oral antibiotic tx or inability to tolerate therapy.
clostridium septicum is associated with
what to get after infection?
spontaneous gas gangrene.
History of trauma is not needed for infection
can spread hematologenously from GI tract
- can have underlying colonic malginancy or IBS or diverticulitis
all pts who have Clostrium septicum infection should have a colonoscopy
non purulent cellulitis without signs of systemic fever can be treated with
cephalexin for 5 to 10 days
when should someone get prophylactic antibiotics to prevent cellulitis?
more than 3 episodes of cellulitis per year
consider penicillin or erythromycin.
when to get blood cultures for someone who has cellulitis?
not routinely indicated for erysipelas and celulitis
get blood cultures on:
immunocompromised,
exhibit severe sepsis or unusual precipitating circumstances (immersion injury)
animal bites
culture of skin tissue aspirate or biopsy should also be considered.
primary treatment for abscesses, furncles and carbuncles
Incision and drainage
Antibiotics after I and D?
mild lesions without SIRS - no
moderate infections with SIRS-yes
also need abx in:
immune compromised
those with hypotension
severe SIRS
in whom I&D or oral antibiotics fail
carbuncle= several furncles that coalesce together. Furncles are boils or follicle associated abscesses that extend into the dermis.
multiple recurrences of cellulitis by MRSA
consider decolonization with topical intranasal mucpirocin and chlorhexidine washes
also consider hidradenitis suppurativa, pilonidal cysts, or foreign body.
someone gets bitten by a human. what to do?
all pts should get short course of prophylactic antibiotic therapy with amoxicillin-clavulanate.
assess for tetanus prophylaxis, and exposure to hep B and C, HIV, and other bodily fluid transmitted pathogens.
diabetic foot infection treatment and duration for
Mild infection
moderate to severe infections:
Mild infections - if they are infected treat with MRSA and strep coverage
can be treated with empiric short course of 7-14 days of oral antibiotics: cephalexin, clindamycin, amoxicillin-clavulanate or dicloxacillin
Would cultures should be by curettage or biopsy of deep tissue before initiating antiobtics - can also use doxycycline or bactrim.
Severe infections: - need polymicrobial coverage with staphyloci, streptococci, and aerobic gram negative bacilli and anaerobes
can treat with 2-4 weeks of antibiotics
necrotizing skin infections like aeromonas hydrophilia (gram neg bacilli) should be treated with
ciprofloxacicin and doxycycline
this is a seen in aquatic environments with freshwater and brackish water and grows best in warmer months
it can cuase soft tissue and blood stream infections with underlying immunocompromising conditions like cirrhosis or cancer.
Treatment of group A (strep pyogenes) necrotizing fasciitis
penicillin and clindamycin - suppress streptococcal toxin production)
