![]() Clindamycin (note: high resistance among MSSA).Alternatives: for severe beta-lactam allergy.Polymicrobial: vancomycin + piperacillin/tazobactam.Aeromonas hydrophila: doxycycline + ciprofloxacin.Vibrio vulnificus: doxycycline + ceftazidime.Necrotizing group A streptococcal or clostridial infection: PCN G + clindamycin.Microbiology/special associations-pathogen-specific: see specific modules for details. ![]() Vancomycin 15 mg IV q 12h IV PLUS piperacillin/tazobactam 3.375 g IV q 4-6h.Emergent surgical consultation, consideration for debridement.Assess for potential necrotizing infection.It may extend in severe cases/slow clinical response.Non-purulent Infections Non-purulent Infections Typical cellulitis or erysipelas + systemic signs of infection.Non-purulent cellulitis: without abscess, necrotizing fasciitis or erysipelas.Purulent infection requires I&D (without the above).Purulent infection with signs of systemic inflammation.Presence of SIRS (≥ 2 of the following: T > 38☌, P > 90, RR > 24, WBC 12,000 cells/υL) and evidence of end-organ damage.Patients who have failed I&D plus oral antibiotics.Purulent-associated cellulitis: associated with an abscess, carbuncle or furuncle.For infection in which culture information is derived, use results to help guide therapy.Classification (Based on 2014 IDSA Guidelines for Diagnosis and Management of Skin and Soft Tissue Infections).Orbital cellulitis is potentially serious and merits an ophthalmology consultation and a CT scan to exclude preseptal infection.Differential diagnosis: allergic reactions, gout, zoster, erythroderma, insect bite reactions, panniculitis, Lyme disease (erythema migrans), Sweet’s syndrome, pyoderma, fixed drug reaction, dermatitis, thrombophlebitis, necrotizing fasciitis.Lymphangitis may develop in a tiny minority of patients.Exam: red, hot, tender skin with edema + fever and adenopathy.Predisposing conditions: trauma, lymph or venous stasis (prior radiation, mastectomy, saphenous vein harvest), chronic edema, skin disorders (e.g., psoriasis), injection drug use, ulcers, wounds, dermatophytic infections, animal bites, neutropenia, chemotherapy, immunocompromise, immersion injuries.Differing from standard cellulitis, the pathogen then is more likely Staphylococcus aureus.Purulent cellulitis (often developing around wound or furuncle, abscess, carbuncle):.Most cases are due to group A Streptococcus, but other streptococci are occasionally implicated, e.g., group G.Cellulitis: deeper (subcutaneous) than erysipelas.Erysipelas: superficial, sharply demarcated-nearly always group A Streptococcus.Definition: though a general term for inflammation, cellulitis in this module means a spreading bacterial infection of the skin.
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