Cellulitis(1) C.L.I.P.S. Etiology Purulent cellulitis: MRSA, Streptococcus Non-purulent cellulitis: MSSA or streptococcus Erysipelas: Beta A Hemolytic streptococcus Diagnosis: Cellulitis manifests as an area of erythema, warmth, and edema; it develops as a result of bacterial entry via breaches in the skin barrier An abscess is a collection of pus within the dermis or subcutaneous space. It manifests as a painful, fluctuant, erythematous nodule, with or without surrounding cellulitis. Erysipelas is a well demarcated cellulitis Fever may be present Laboratory testing is not required for patients with uncomplicated infection in the absence of comorbidities or complications. Blood cultures are warranted in the following cases: systemic toxicity, extensive skin or soft tissue involvement, Underlying comorbidities (lymphedema, malignancy, neutropenia, immunodeficiency, splenectomy, diabetes), animal bite, persistent cellulitis, cellulitis overlying medical device. Who is most at risk for a MRSA cellulitis infection? Patient’s who inject IV drugs and those with uncontrolled diabetes. Updated 3/2018 Maston

When do you transition IV Abx to oral Abx? Cellulitis(2) C.L.I.P.S. Treatment Non purulent cellulitis: Use oral regimen if patients are stable. Choose Abx that cover beta hemolytic strep and MSSA (Cephalexin, Clindamycin). Purulent cellulitis: drain the abscess if possible. Cover for MRSA in these cases with Vancomycin, Doxycycline, Bactrim or Clindamycin if indicated. If a healthy patient has isolated abscess <2cm w/o surrounding cellulitis, antibiotics coverage is not necessary. In most other cases with purulent cellulitis antibiotics are necessary. IV Abs should be initiated when: systemic toxicity is present, rapid progression of erythema, progression of clinical findings after 48 hours of oral abx therapy, and/or inability to tolerate oral therapy Other Complications Sepsis, osteomyelitis, recurrent infection. Prevention (based on etiology) Good glycemic control Healthy weight Harm reduction for IVDU (needle exchange), access to substance use counseling and treatment When do you transition IV Abx to oral Abx? Signs of clinical improvement and no evidence of systemic toxicity