Cellulitis and Soft Tissue Infections Author: Dennis L. Stevens, PhD, MD; Lawrence J. Eron, MD, FACP
Editorial changes - 2008-08-20
Author information and module status
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up
Tables
Figures
References
Glossary
What's New
Patient Information
Additional Resources
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Prevention
  • Prevent transmission of MRSA to patients with wounds or intravenous lines.
  • Provide appropriate care to patients with wounds to prevent serious soft tissue infections.
  • Prevent infection of plantar ulcers in diabetic patients.
  • Prevent infection following human and animal bites.
  • Prevent wound infections following surgery by meticulous surgical technique as well as by antimicrobial prophylaxis.

Prevent transmission of MRSA to patients with wounds or intravenous lines. A

  • Prevent transmission of MRSA by strictly observing published guidelines.
  • Perform hand hygiene after contact with all patients.
  • Use gown and glove (barrier precautions) before examining wounds infected with MRSA.
  • Disinfect stethoscopes with alcohol wipes after contact with MRSA-colonized or infected patients.
  • See table Risk Factors for Specific Pathogens.
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Provide appropriate care to patients with wounds to prevent serious soft tissue infections. C

  • Treat superficial soft tissue infections after minor trauma, such as burns, lacerations, and abrasions, by meticulous cleansing of the trauma site with antibacterial soap.
  • Prevent cracking of the skin by keeping the skin well hydrated with emollients.
  • Prevent tinea pedis by treating interdigital skin maceration.
  • Treat deep traumatic injuries, such as crush injuries and open fractures, and particularly those with vascular injury or gross contamination with soil, by:
    • Cleansing the wound of soil and foreign material
    • Copious saline irrigation
    • Surgical debridement
    • Reanastomosis of injured vessels
    • Leaving the wound open to heal by secondary intention
    • Administration of antimicrobial prophylaxis (see Prevention of surgical site infection)
  • Ascertain tetanus immunization status.
  • See table Risk Factors for Specific Pathogens.
  • See table Drug Treatment for Soft Tissue Infections.
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Prevent infection of plantar ulcers in diabetic patients. C

  • Treat superficial foot ulcers with aggressive cleansing and off-weighting of the ulcerated area.
  • Shave down plantar calluses.
  • Instruct patients to inspect plantar surfaces of their feet with a mirror on a daily basis.
  • Educate patients about neuropathy-related injuries to the skin, foot care, proper shoes, and prompt recognition and treatment of plantar ulcers.
  • See table Risk Factors for Specific Pathogens.
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Prevent infection following human and animal bites. B

  • Irrigate wounds with copious amounts of saline.
  • Use amoxicillin/clavulante to prevent:
    • Infection following human bites, especially for closed fist injuries
    • Infection following cat bites
    • Infection following dog bites, when there is extensive injury to soft tissue or when the bite site is near a joint or bone
  • Use prophylaxis for human bites with moxifloxacin plus clindamycin if allergic to pencillin.
  • Use prophylaxis for cat bites with doxycycline or moxifloxacin plus clindamycin if allergic to penicillin.
  • Do not suture wounds closed unless on the face and in this case always use antimicrobial prophylaxis.
  • Consider approximating the edges of the wound with sterile adhesive strips and/or delayed primary closure.
  • Follow closely if the wound is closed due to increased possibility of wound infection.
  • Ascertain tetanus immunization status.
  • Administer rabies prophylaxis if the animal could be rabid as in the case of a skunk, fox, or raccoon bite.
  • See table Risk Factors for Specific Pathogens.
  • See table Antimicrobial Treatment of Human and Animal Bites.
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Prevent wound infections following surgery by meticulous surgical technique as well as by antimicrobial prophylaxis. A

  • Use good hand hygiene.
  • Use good surgical technique, including:
    • Gentle traction
    • Effective hemostasis
    • Removal of devitalized tissues
    • Obliteration of dead space
    • Irrigation of tissues
    • Fine, non-absorbable monofilament suture material
    • Closed suction drains
    • Wound closure without tension
  • Administer single-dose antimicrobial prophylaxis before incision:
    • Use cefazolin or cefuroxime for clean surgery; use clindamycin or vancomycin if allergic to penicillin
    • Use cefoxitin or ampicillin/sulbactam or metronidazole/cefazolin for gastrointestinal surgery; use clindamycin or vancomycin plus aztreonam or ciprofloxacin if allergic to penicillin
  • See table Risk Factors for Specific Pathogens.
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FAQs
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.

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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