Cellulitis
Bacterial infection of dermis and subcutaneous tissue. Most common organisms: S. aureus, S. pyogenes. Risk: skin breakdown, diabetes, immunosuppression, lymphedema, IV drug use. Presentation: erythema (warm, tender, edematous, poorly demarcated), fever, chills. Erysipelas: more superficial, raised, well-demarcated. Diagnosis: clinical. Mark borders with marker to track progression.
Severe Soft Tissue Infections
Necrotizing fasciitis: rapidly spreading infection, severe pain out of proportion, crepitus (gas), bullae, skin necrosis, septic shock — emergency. Risk: diabetes, immunosuppression, IV drug use. MRSA: increasing cause. Abscess: localized collection of pus — needs incision and drainage (I&D). MSSA vs MRSA determines antibiotic choice.
Nursing Management
Cellulitis: oral antibiotics for mild (dicloxacillin, cephalexin — 5-7 days), IV for severe (vancomycin if MRSA risk). Mark borders with marker, monitor progression. Elevate affected area. Warm compresses. Pain management. Monitor for spread, sepsis. Abscess: I&D, wound care, antibiotics. Necrotizing fasciitis: immediate surgical debridement, broad-spectrum antibiotics, ICU. Monitor for septic shock.
Important Notes
- Necrotizing fasciitis: severe pain out of proportion to visible findings, crepitus, rapidly spreading — surgical emergency requiring immediate debridement.
- Mark cellulitis borders with a marker at presentation to track progression — spreading beyond marks warrants escalation.
Clinical Tips
- Diabetic patients with cellulitis need careful monitoring — high risk for necrotizing fasciitis and rapid progression.
- If MRSA suspected (risk factors, prior history), add vancomycin or linezolid to empiric coverage.
Summary
Cellulitis management requires antibiotics (oral/IV), border marking, elevation, and immediate recognition of necrotizing fasciitis as a surgical emergency.
