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SOURCE

Source: Fish DN. Skin and soft-tissue infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146071658. Accessed March 20, 2017.

DEFINITION

  • Acute infectious process that initially affects the epidermis and dermis and may spread subsequently within the superficial fascia.

ETIOLOGY

  • Most often caused by Streptococcus pyogenes or Staphylococcus aureus

  • Increased incidence of methicillin-resistant S. aureus (MRSA) of major concern.

  • Mixed aerobic and anaerobic pathogens seen:

    • Diabetic patients.

    • IV drug abusers.

    • Following traumatic injuries.

    • Sites of abdomen or perineum surgical incisions.

    • Patients with compromised host defenses (eg, vascular insufficiency)

PATHOPHYSIOLOGY

  • Spreading inflammatory infection following wound from minor trauma, abrasion, ulcer, or surgery.

EPIDEMIOLOGY

  • Considered a serious infection due to propensity to spread through lymphatic tissue and to bloodstream.

  • Four million patients were hospitalized for cellulitis between 1998 and 2006, representing 10% of all infection-related hospital admissions during that time.

PREVENTION

  • Good wound care.

RISK FACTORS

  • Injection drug use.

  • History of antecedent wound from minor trauma, abrasion, ulcer, or surgery.

  • Poor nutrition.

CLINICAL PRESENTATION

  • Characterized by erythema and edema of the skin.

SIGNS AND SYMPTOMS

  • Fever.

  • Chills.

  • Malaise.

  • Erythema and edema of skin; affected areas warm to touch.

  • Lesions nonelevated, with poorly defined margins.

  • Inflammation present, with little or no necrosis or suppuration of soft tissue.

  • Tender lymphadenopathy.

DIAGNOSIS

MEANS OF CONFIRMATION AND DIAGNOSIS

  • Diagnosis usually based on appearance of lesion.

LABORATORY TESTS

  • Complete blood count (CBC): leukocytosis common.

  • Cultures of affected area may be difficult.

  • Gram stain of fluid obtained by injection and aspiration of saline.

  • Blood cultures: bacteremia present in as many as 30% of cellulitis cases.

DIAGNOSTIC PROCEDURES

  • Injection and aspiration of 0.5 mL saline into advancing edge of lesion may aid microbiologic diagnosis, but is often negative.

DIFFERENTIAL DIAGNOSIS

DESIRED OUTCOMES

  • Rapid eradication of infection.

  • Prevention of complications.

TREATMENT: GENERAL APPROACH

  • Selection of antimicrobial therapy directed toward type of bacteria documented to be present or suspected.

TREATMENT: NONPHARMACOLOGIC THERAPY

  • Elevation and immobilization of involved area to decrease local swelling.

  • Cool, sterile saline dressings may decrease pain.

    • Follow with moist heat to aid in localization of infection.

    • Surgical incision and drainage rarely indicated in uncomplicated disease.

TREATMENT: PHARMACOLOGIC THERAPY

  • Antibiotic selection is ...

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