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Cellulitis


The point of observing cellulitis is less about making it clinically improve, but rather making sure the patient doesn't clinically worsen



Inclusion Criteria

  • Serial exams needed to exclude rapidly progressive cellulitis
  • Cellulitis which requires > 1 dose antibiotics
  • Temp < 40.C, WBC < 16,000 and WBC >4,000.
  • Cellulitis with a drained abscess which requires a brief period of observation and wound care

Exclusion Criteria

  • Septic or toxic patients โ€“ clinical appearance, evidence of severe sepsis (Temp >40, SBP<100, RR>22, HR>100, *acute organ dysfunction, lactate >4mmol/L )
  • Immunocompromized patients โ€“ neutropenia, HIV, transplant patients, ESRD/hemodialyisis patients, patients on immunosuppressants or chemotherapy, post-splenectomy patients.
  • High risk infections โ€“ diabetic foot infections; infections proximate to a prosthesis, percutaneous catheter or *indwelling device; infections of the orbit or upper lip/nose, neck; infections of >9% TBSA; extensive tissue sloughing; suspicion of osteomyelitis or deep wound infection.

Potential Interventions

  • Mark edges of cellulitis with indelible marker to monitor progression
  • IV antibiotics - MRSA coverage as indicated (Vancomycin, Bactrim, Clinda, Doxycycline)
  • Pertinent labs (CBC, glucose, blood or wound cultures PRN)

Discharge Criteria

Home

    • Improvement or no progression of cellulitis
    • Improved and good clinical condition (ie. No fever, good VS) for 8 hrs.
    • Able to perform cellulitis care at home and take oral medications

Admit

    • Increase in skin involvement
    • Clinical condition worse or not better (i.e. rising temp, poor vitals)
    • Unable to take oral medications
    • Unable to care for wound at home, home care unavailable




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