Cellulitis

• What are some risk factors for developing cellulitis?

  PVD

  Obesity

  Skin breaks

  Lymphoedema

  Surgery

  Tinea pedis

  Skin conditions

  Diabetes
• How does cellulitis develop?

  Bacteria enters through a break in the skin
• What are the most common bacterial causes of cellulitis?

  Streptococcus pyogenes

  Group A strep

  Staph aureus
• How may someone present with cellulitis?

  Acute onset

  Usually unilateral (mostly in the shins)

  Erythema

  Swelling

  Fever

  Malaise
• What criteria is used to classify how to manage cellulitis patients?

  Eron classification
• What are the features in Class I Eron classification for cellulitis?

  No signs of systemic toxicity + no uncontrolled co-morbidities
• What are the features in Class II Eron classification for cellulitis?

  Can be either systemically well or unwell but HAS a comorbidity
• What are the features in Class III Eron classification for cellulitis?

  Significant systemic upset OR unstable co-morbs that may interfere with response to treatment OR limb threatening infection due to vasc compromise
• What are the features in Class IV Eron classification for cellulitis?

  Has sepsis syndrome OR severe life-threatening infection e.g. necrotising fasciitis
• When are patients admitted for IV antibiotics with cellulitis?

  Eron class III or IV

  Severe cellulitis

  Age (<1 yr)

  Immunocompromised

  Facial cellulitis
• What are some investigations for cellulitis?

  FBC

  U&Es

  CRP or ESR

  Wound swab

  Blood cultures
• What do you specifically look for in a FBC for cellulitis and why?

  Leukocytosis - more severe infection -> guide treatment options
• What guides the management for cellulitis?

  Eron class
• What is the suggested management for Eron class I cellulitis patients?

  Oral antibiotics
• What is the firstline antibiotic for mild/moderate cellulitis?

  Fluclox
• What antibiotic is used for patients with cellulitis that are ALLERGIC to penicillin

  Clarithromycin/erythromycin (in pregnancy) OR doxycycline
• What does NICE recommend for Eron class II cellulitis patients?

  Admission may not be necessary if IV antibiotics can be given in the community and monitored - check local guidelines.
• What is the suggested management for Eron class III-IV cellulitis patients?

  Admit

  IV/oral antibiotics
• Which antibiotics can be used to manage Eron class III/IV cellulitis patients?

  Oral/IV co-amox

  Oral/IV clindamycin

  IV cefuroxime

  IV ceftriaxone
• What are some general management points for patients with cellulitis?

  Mark area of erythema - detect spread

  Elevate the leg (if possible)

  Paracetamol or ibuprofen for pain or fever
• What are some complications for cellulitis?

  Systemic infection

  Subcut abscess formation

  Myositis

  Fasciitis

  Death

  Recurrent cellulitis