Cellulitis and other skin and soft-tissue infections (SSTIs) are common presentations in the emergency department. Our recent issue Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infections describes the varied etiologies and patient presentations of the more common SSTIs: cellulitis, abscesses, and necrotizing soft-tissue infections.
A discussion of the common diagnoses masquerading as SSTIs is presented, as well as a stepwise approach to avoiding misdiagnosis. Diagnostic studies are also evaluated, including discussions on ultrasound, computed tomography, and clinical decision rules.
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Here are a few key points:
- With some 2 million cases of SSTIs presenting to EDs annually, their misdiagnosis and mismanagement leads to hundreds of millions of dollars of avoidable healthcare spending and increased risk for morbidity and mortality.
- SSTIs can be distinguished by their location in the soft tissue: erysipelas is superficial; cellulitis is in the dermal layers; and necrotizing infection is in the deeper dermal and fascial layers. (See Figure 1 in the issue.)
- Purulent cellulitis is predisposed for Staphylococcus species; the IDSA recommends empiric coverage for MRSA for these patients.
- Nonpurulent cellulitis has a predominance toward infection with Streptococcus species.