![]() ![]() Group A strep remains susceptible to beta-lactam antibiotics. 7 Due to the difficulty of determining the causative pathogen for most cellulitis cases, clinicians may select antibiotics that cover both Staphylococcus aureus and group A strep. Treatmentįor typical cases of non-purulent cellulitis, IDSA recommends treatment with an antibiotic that is active against streptococci. 7 Waiting for culture results should never delay the initiation of treatment however, when available, culture results can be used to tailor antibiotic therapy. These procedures are recommended by IDSA in those with immunocompromised status, immersion injuries, or animal bites. 7 However, blood culture and microbiologic examination and culture of cutaneous aspirates, biopsies, and swabs may help when atypical pathogens are suspected. 1,4,6 Diagnosis and testingĭiagnosis of cellulitis is usually made clinically.įor cellulitis, the Infectious Diseases Society of America (IDSA) does not recommend routine collection of cultures, including blood, cutaneous aspirates, biopsies, or swabs. 1,4,5 Previous history of cellulitis venous insufficiency, presence of chronic edema, or impaired lymphatic drainage of the limbs obesity and injection drug use have also been identified as risk factors for cellulitis. 1ĭisruption of the cutaneous barrier, such as presence of ulcers, wounds, or fungal skin infections (e.g., athlete’s foot), is a risk factor for developing cellulitis. Local dermatophyte infection (e.g., athlete’s foot) may serve as portal of entry for group A strep. 3 People with active infection are more likely to transmit group A strep compared to asymptomatic carriers. Transmissionĭirect person-to-person transmission of group A strep can occur through contact with skin lesions or exposure to respiratory droplets. 1 An elevated white blood cell count may also be present. 2 Systematic symptoms, such as fever, chills, and malaise, may be present, and can be accompanied by lymphangitis and, less frequently, bacteremia. Local signs of inflammation (warmth, erythema, and pain) are present in most cellulitis cases. 1 As a result, the affected skin usually has a pinkish hue with a less defined border, compared to erysipelas that presents with well-demarcated borders and a bright red color. Clinical featuresĬellulitis affects structures that are deeper than areas affected by impetigo or erysipelas. They belong to group A in the Lancefield classification system for β-hemolytic Streptococcus, and thus are also called group A streptococci. They exhibit β-hemolysis (complete hemolysis) when grown on blood agar plates. pyogenes are gram-positive cocci that grow in chains ( see Figure 1). pyogenes are one of the most common causative pathogens for cellulitis. It can be caused by multiple bacteria, but this page will focus on cellulitis caused by Streptococcus pyogenes, which is also called group A Streptococcus (group A strep). Cellulitis is an infection that occurs in the subcutaneous tissues. ![]()
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