Cellulitis and Soft Tissue Infections

1. Cellulitis and Soft Tissue Infections Pamela Orr Professor, Internal Medicine, Medical Microbiology and Community Health Sciences

17. Investigation • Blood cultures if fever history/objective fever/chills/systemic symptoms or signs/immunosuppressed • Check for Tinea pedis if lower extremity involved • Culture any open wounds (including anaerobic culture if deep or necrotic or malodorous) • CBC, urea, creatinine, glucose • Image – eg. CT of orbit and brain • Incise and drain and pack !!

18. Treatment • Cellulitis not associated with wound – usually Streptococcus A (B/C/G) / MSSA/ MRSA (or Strep Pneumoniae or Haemophilus influenzae in orbital cellulitis) • iv Ceftriaxone 2 gm/day +/- iv Vancomycin • Pen allergy: iv Clindamycin or Vancomycin • Oral: Cloxacillin or Cephalexin (or Clinda if Pen allergic) - add Septra or Doxycycline if MRSA is suspected • Cefuroxime-axetil in orbital cellulitis • Eryripelas – Strep A • iv Ceftriaxone (or Pen or Ampicillin) • Pen Allergy: iv Clindamycin (or Vanco) • Oral: Penicillin V or Amoxil (or Clinda if Pen allergic)

19. Treatment Diabetic Foot Infection – usually mixed gram +/-/anaerobes. Decide whether osteomyelitis is present, and assess arterial pulses. Often needs iv therapy. Start with (after cultures): • eg. iv Ceftriaxone +iv Vanco+ po Metronidazole • eg. po Amoxicillin/Clavulinic Acid +/- Doxy, or po Septra + Metro Wound Infection – likley mixed infection, as above. Same approach. If Water exposure think of Pseudomonas – use Ceftazidime or Ciprofloxacin instead of Ceftriaxone Head and Neck Region Infections: Be very cautious