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Rationale:
- Superficial infections after minor breaks in the skin barrier are usually caused by indigenous skin flora, such as S. aureus and group A streptococci.
- In patients with normal host-defense mechanisms and normal blood vessels, simple cleansing of wounds is sufficient.
- In patients with comorbidities predisposing to infection, use neomycin or mupirocin ointment when MRSA is present.
- Closure of lacerations overlying traumatized tissue, particularly in the case of a crush injury or a comminuted fracture,
increases the patient's risk of developing an infection.
- Injuries associated with interruption of the blood supply are the most likely to become infected.
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Evidence:
- Antimicrobial prophylaxis may prevent infection following traumatic injuries (12).
- In two bacteremic patients with cellulitis, toe web cultures and blood cultures showed identical strains of β-streptococci
(13).
- Retapamulin ointment may be useful when mupirocin-resistance in MRSA is suspected or proven (14).
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Comments:
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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,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Cellulitis and Soft Tissue Infections
> Prevention
