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Source: Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th edition. Accessed July 21, 2012.

  • Acute, spreading, infectious process that initially affects epidermis and dermis; may subsequently spread within superficial fascia.
    • Process characterized by inflammation but with little or no necrosis or suppuration of soft tissue.

  • Most often caused by S. pyogenes or S. aureus.
  • Increased incidence of methicillin-resistant S. aureus (MRSA) of major concern.
  • Mixed aerobic and anaerobic pathogens seen:
    • In diabetics
    • Following traumatic injuries
    • At sites of abdomen or perineum surgical incisions
    • With compromised host defenses (e.g., vascular insufficiency)

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

  • Considered a serious infection due to propensity to spread through lymphatic tissue and to bloodstream.
  • 10% of all infection-related hospital admissions between 1998 and 2006

  • Good wound care

  • Injection drug use
  • History of antecedent wound from minor trauma, abrasion, ulcer, or surgery.
  • Poor nutrition

  • 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

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

  • Rapid eradication of infection
  • Prevention of complications

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

  • 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.

  • Administration of semisynthetic penicillin (nafcillin or oxacillin) or first-generation cephalosporin (cefazolin) recommended until definitive diagnosis, by skin or blood cultures, can be made (Tables 1 and 2).
  • Oral or parenteral clindamycin recommended for penicillin-allergic patients.
  • Usual duration of therapy: 5–10 days
    • If caused by gram-negative bacilli or mixture of microorganisms, treat for 10–14 days.

Table 1. Evidence-Based Recommendations for Treatment of Skin and Soft-Tissue ...

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