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- Hospitalize patients with cellulitis or soft tissue infection who have signs of severe infection.
- Assess patient suitability for outpatient parenteral antibiotic therapy or outpatient oral antimicrobial therapy.
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Hospitalize patients with cellulitis or soft tissue infection who have signs of severe infection.  |
- Stratify patients with soft tissue infections according to the severity of infection and complicating comordities as a means of determining the need for outpatient treatment or hospitalization, the need for surgery, and the need for oral or parenteral antimicrobials.
- Hospitalize patients with signs of serious infection including:
- Clinical signs of sepsis syndrome
- Limb-threatening infection, including necrotizing fasciitis
- A need for surgical drainage or debridement
- Gas in tissue
- Laboratory evidence of multiorgan failure
- Provide surgical evaluation, intravenous fluids, parenteral antibiotics, intensive care monitoring, and ventilator and hemodialysis support, as needed.
- Consider observation status for patients with moderate infections to determine whether they need inpatient treatment or can be managed as outpatients.
- Consider hospitalization for some patients whose noncompliance would severely interfere with appropriate outpatient care of their infection.
- Hospitalize patients who lack sufficient support at home to adequately treat their infection.
- Discharge patients once the infection is no longer spreading and other parameters of inflammation such as leukocytes are trending towards normal.
- See figure Necrotizing Infections Associated With Gas in the Tissue [A].
- See figure Necrotizing Infections Associated With Gas in the Tissue [B].
| Background | Back to top
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Assess patient suitability for outpatient parenteral antibiotic therapy or outpatient oral antimicrobial therapy. |
- Base consideration for outpatient parenteral antibiotic therapy on clinical criteria and available social support systems.
- Do not consider outpatient therapy in patients with:
- Limb-threatening infection
- Sepsis syndrome
- Crepitus
- Need for surgical intervention
- Uncontrolled diabetes
- Uncontrolled pain
- Uncontrolled nausea, vomiting, or diarrhea
- Drug abuse
- Nonadherence
- Inadequate home support
- Be aware that certain antimicrobial agents due to their pharmacokinetic properties are more appropriate for outpatient parenteral antibiotic therapy:
- Cephalosporins, particularly ceftriaxone (once daily) or cefazolin (either twice daily or once daily with oral probenecid) if MRSA is unlikely
- 24-hour continuous infusion of penicillins, provided intravenous access is suitable (e.g., peripherally inserted central catheter line or midline) and that automated devices for continuous infusion are available
- Daptomycin (once daily) if MRSA is present or suspected to be present
- Dalbavancin (once weekly) if MRSA is present or suspected to be present
- Ertapenem (once daily) if gram-negative bacilli and/or anaerobic organisms are present
- Recognize that the availability of well-trained intravenous-certified nurses and 24-hour medical coverage is a prerequisite for good-quality management of these patients.
- Recognize that oral antimicrobials with excellent bioavailability may be preferable to parenteral options, including:
- Linezolid
- Trimethoprim-sulfamethoxazole
- Doxycycline/minocycline
- Fluoroquinolones (moxfloxacin, gatifloxacin, levofloxacin)
- Metronidazole
- Chloramphenicol
- Clindamycin
- Triazole antifungals (fluconazole, voriconazole)
| Background | Back to top
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| Dennis L. Stevens, PhD, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lawrence J. Eron, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2009 by the American College of Physicians,
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Cellulitis and Soft Tissue Infections
