Skin and Soft tissue infections

Question 1

Cellulitis

Answer 1

Cellulitis is an infection of the skin and the soft tissues underneath. The skin normally acts as a very effective physical barrier between the environment and soft tissues. When a patient presents with cellulitis look for a breach in the skin barrier and a point of entry for the bacteria. This may be due to skin trauma, eczematous skin, fungal nail infections or ulcers.

Question 2

Cellulitis presentation

Answer 2

The skin will demonstrate changes:

Erythema (red discolouration)
Warm or hot to touch
Tense
Thickened
Oedematous
Bullae (fluid filled blisters)
A golden-yellow crust can be present and indicate a staphylococcus aureus infection

Question 3

Causes of cellulitis

Answer 3

The most common causes are:

Staphylococcus aureus
Group A Streptococcus (mainly streptococcus pyogenes)
Group C Streptococcus (mainly Streptococcus dysgalactiae)

Other causes
MRSA

Question 4

Classification of cellulitis

Answer 4

This is the classification system NICE recommends for the assessment of the severity of cellulitis:

Class 1 – no systemic toxicity or comorbidity
Class 2 – systemic toxicity or comorbidity
Class 3 – significant systemic toxicity or significant comorbidity
Class 4 – sepsis or life threatening

Admit the patient for intravenous antibiotics if they are class 3 or 4. Also consider admission for frail, very young or immunocompromised patients.

Question 5

Abx to treat cellulitis

Answer 5

Flucloxacillin is very effective against staph infections and also works well against other gram positive cocci. It is usually the first choice in treating cellulitis and can be given oral or intravenous.

Alternatives:

Clarithromycin
Clindamycin
Co-amoxiclav