cellulitis, NF, gas gangrene

1. By: dr ismah
Ortho department
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hospitals.unm.edu

3. • Skin and soft-tissue infections (SSTIs) are a common
reason for presentation to outpatient practices,
emergency rooms, and hospitals
• They account for more than 14 million outpatient visits in
the United States each year and visits to the emergency
room and admissions to the hospital for them are
increasing
• Hospital admissions for SSTIs increased by 29% from
2000 to 2004
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Edelsberg J, Taneja C, Zervos M, et al. Trends in US hospital admissions
for skin and soft tissue infections. Emerg Infect Dis 2009; 15:1516–1518.

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Erysipelas
NF
Cellulitis
Gas
gangrene
Cleveland Clinic Journal of Medicine-2012-RAJAN-57-66

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Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections:
2014 Update by the Infectious Diseases Society of America

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8. • Often caused by Group A β - haemolytic streptococci,
(Streptococcus pyogenes)
• The infected area is painful, hot and oedematous
• Non-raised skin lesions with indistinct margin, sometimes with
lymphangitis
• There is usually no localization of the infection or pus
formation
• May associate with insect bites, trauma or ill fitting shoes
• IV C Pen 2.4 Mu, IV Cloxacillin. Dressing with CHD cream
Cleveland Clinic Journal of Medicine-2012-RAJAN-57-66 8

9. INDICATIONS FOR ADMISSION:-
• Severe or rapidly worsening infection
• Patient systemically unwell
• Uncertainty regarding the diagnosis (need to out rule
DVT)
• Immunocompromised patient. Diabetes mellitus – if
unstable
• Children under one year of age or elderly without good
home support
Johnny Loughnane
• Lack of response to home treatment Irish College at 48 of General hours Practitioners April 2006
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Cellulitis

11. • An aggressive subcutaneous infection that tracks along
the superficial fascia, which comprises all the tissues
between the skin and underlying muscles
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections:
• Rapid progression
• Physical exam
 Skin bullae
 Ischemic patches
 Swelling, edema
 Crepitus
2014 Update by the Infectious Diseases Society of America
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13. • Features that suggest involvement of deeper tissues
include
(1) severe pain that seems disproportional to the clinical
findings; (2) failure to respond to initial antibiotic therapy;
(3) the hard, wooden feel of the subcutaneous tissue,
extending beyond the area of apparent skin involvement;
(4) systemic toxicity, often with altered mental status;
(5) edema or tenderness extending beyond the cutaneous
erythema;
(6) crepitus, indicating gas in the tissues;
(7) bullous lesions;
(8) skin necrosis or ecchymoses
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Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections:
2014 Update by the Infectious Diseases Society of America

14. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection :
diagnosis and management. ClinInfect Dis 2007; 44:705–710,
Oxford University Press.
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16. • Surgical debridement
• Antibiotic
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Type 1 Type 2
Polymicrobial infection.
Immunocompromised.
Group A strep
Cloxacillin 2g IV q4-6h
PLUS
Metronidazole 500mg IV q8h
PLUS
Gentamicin1 5mg/kg IV q24h
Benzylpenicillin 2-4 mega units IV
q4h
PLUS
Clindamycin 600mg IV q8h
ALTERNATIVES:
3rd gen. Cephalosporins
PLUS
Metronidazole 500mg IV q8h
OR
β-lactam/β-lactamase inhibitors, e.g.
Ampicillin/Sulbactam 1.5g IV q8h
OR
Amoxycillin/Clavulanate 1.2g IV q8h
PLUS/MINUS
Gentamicin1 5mg/kg IV q24h
National_Antibiotic_Guideline_2008

17. • Clostridium perfringens
• Gram-positive obligate anaerobic spore-forming rods that
produce exotoxins
• Causes muscle necrosis and vessel thrombosis,
hemolysis and shock
• Rx : Benzylpenicillin 2-4 mega units IV q4h PLUS
Metronidazole 500mg IV q8h PLUS/MINUS Gentamicin1
5mg/kg IV q24h
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18. swelling,
edema, discoloration and
ecchymosis, blebs and
hemorrhagic bullae
University of Kansas Medical Center- http://www.kumc.edu/ 18