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SKIN & SOFT TISSUE INFECTIONS
CELLULITIS
OVERVIEW
Skin and soft tissue infections result from the microbial invasion of the skin and its supporting structures. Management is determined by the severity and location of the infection and by patient comorbidities. Infections can be classified as simple (uncomplicated) or complicated (necrotizing or Nonnecrotizing), or as suppurative or nonsuppurative. Most community-acquired infections are caused by methicillin-resistant Staphylococcus aureus and beta-hemolytic streptococcus. Simple infections are usually monomicrobial and present with localized clinical findings. In contrast, complicated infections can be mono- or polymicrobial and may present with systemic inflammatory response syndrome. The diagnosis is based on clinical evaluation. Laboratory testing may be required to confirm an uncertain diagnosis, evaluate for deep infections or sepsis, determine the need for inpatient care, and evaluate and treat comorbidities. The initial antimicrobial choice is empiric, and in simple infections should cover Staphylococcus and Streptococcus species. Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for debridement. Superficial and small abscesses respond well to drainage and seldom require antibiotics. Immunocompromised patients require early treatment and antimicrobial coverage for possible atypical organisms.
WHAT IS CELLULITIS?
Cellulitis is a serious bacterial infection of the skin. Bacteria break through the skin's protective outer layer, typically at the site of an injury, such as a cut, puncture, sore, burn or bite. Cellulitis can occur at the site of surgery, or where there is a catheter. Once beneath the skin surface, bacteria multiply and make chemicals that cause inflammation in the skin.
IS CELLULITIS CONTAGIOUS?
Cellulitis is not contagious.
Anyone can get cellulitis, including children. A wound such as a cut, ulcer, animal bite, or surgical site puts a person at risk for cellulitis. Some people, however, particularly those with a weakened immune system, can get cellulitis without a cut or sore.
Skin and soft tissue infections (SSTIs) account for more than 14 million physician office visits each year in the United States, as well as emergency department visits and hospitalizations.
WHAT CAUSES CELLULITIS?
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Cellulitis can be caused by many different bacteria. The most common organisms are group A streptococci and S. aureus. Cellulitis that develops in the setting of a chronic ulcer is often caused by a mix of bacterial species.
SYMPTOMS OF CELLULITIS
An individual with cellulitis often notices prominent symptoms in the affected area. These symptoms include:
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Red area of skin that tends to expand.
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Swelling
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Tenderness
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Pain
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Warmth
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Fever
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Red spots
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Blisters
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Skin dimpling
It's important to identify and treat cellulitis early because the condition can spread rapidly throughout your body.
Seek emergency care if:
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You have a red, swollen, tender rash or a rash that is changing rapidly.
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You have a fever.
See your doctor, preferably that day, if:
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You have a rash that is red, swollen, tender, and warm — and it is expanding — but without fever.
DIAGNOSING CELLULITIS
Your doctor can usually diagnose cellulitis based on your symptoms and a visual inspection of your skin.
TREATMENT
Cellulitis is treated with antibiotics. Your doctor will choose a specific antibiotic depending on the site of your cellulitis and the probable cause of your infection. Most cases of cellulitis improve quickly once you start taking antibiotics.
If you have mild cellulitis, you can usually treat it at home with antibiotics taken by mouth. However, stay connected with your doctor to be sure that the infection is improving as expected. At home, warm compresses, such as a warm, moist washcloth, and elevating the infected area can help.
If you have severe cellulitis, you may need to be treated in the hospital with antibiotics given intravenously (into a vein).
Community-acquired MRSA infections may worsen despite antibiotic treatment because the antibiotics that are most selected to treat cellulitis do not reliably kill these bacteria. If within the first two or three days of treatment you do not have an obvious improvement in your skin pain, redness, and swelling, or if you develop blisters or pus on the surface of your skin rash, contact your doctor immediately. These can be signs of community-acquired MRSA infection.
PROGNOSIS FOR CELLULITIS
Cellulitis can usually be cured with a course of the appropriate antibiotic, especially if it is diagnosed and treated early. It is particularly important
to take cellulitis seriously and get prompt treatment. It can quickly progress and lead to more serious conditions such as bacteremia (when the bacteria spreads to the bloodstream) or endocarditis (when the bacteria infect the heart).
See your doctor right away if you notice any symptoms of cellulitis.