Authors: Taylor M. Douglas MD, Taylor Conrad, MD, Ted Segarra, MD, Rithvik Balakrishnan MD, Christianna Sim, MD, MPH
Editors: Kelly Maurelus MD FAAEM, Kami Hu MD FAAEM
Originally published:
Common Sense
November/December 2019
Skin and soft tissue infections (SSTIs) result in over two million visits to the emergency department (ED) every year. While this term encompasses infections ranging from erysipelas to necrotizing fasciitis, this article focuses on superficial cellulitis. Due to the lack of good data, there is no true consensus in the medical community regarding standard of care, i.e. whether intravenous (IV) antibiotics are required or what clinical presentations mandate admission. The Infectious Disease Society of America (IDSA) makes recommendations for treatment duration (five days), when to cover methicillin-resistant Staphylococcus aureus (MRSA) [penetrating wounds, intravenous drug use, systemic inflammatory response syndrome (SIRS), nasal colonization, evidence of other MRSA infection] and outpatient management (for those without SIRS, altered mental status, or hemodynamic instability) 1. Most of these guidelines, however, are based on retrospective studies. Studies in the surgical field have attempted to identify grading systems to help guide management without success.2 Without consensus, emergency physicians are left with the following questions on how to best treat and disposition our patients with cellulitis to ensure their infection resolves.