Microbiologic Evaluation of Cutaneous Cellulitis in Adults

Streptococcal Cellulitis/Erysipelas of the Lower Leg

“…Swelling and pain may be severe; blistering, lymphangitis, and/or lymphadenopathy may occur. Although it is often used as a diagnostic criterion, significant pyrexia may be absent in more than half of patients admitted to hospital [5,6].…”

Lower limb cellulitis and its mimics

“…1,3,6,7,22,39,42 The Infectious Disease Society of America (IDSA) guidelines on methicillin-resistant Staphylococcus aureus (MRSA) have labeled cases with such identifiable portals of entry as ''purulent cellulitis'' when associated with suppurative exudates but without a drainable abscess. 43 The white blood cell count is elevated in about 35% to 50% of patients, 1,7,39,40,46 the erythrocyte sedimentation rate (ESR) in 60% to 92% of patients, 7,39,46 and the C-reactive protein level in 75% to 95% of patients, 7,46 but these nonspecific findings, present in numerous disorders, are not very helpful as investigative tools. The important clinical point is that a normal value in any of these studies does not exclude the diagnosis of cellulitis.…”

Management of Skin and Soft-Tissue Infections in the Emergency Department

“…Investigations into the etiology of cellulitis without drainage are limited by the lack of specimen availability. Studies using tissue biopsies and aspirate specimens, and relying on conventional and nonconventional identification methods, such as immunofluorescence and serologic testing, suggest that S. aureusdand to much lesser extent streptococcidare the most common pathogens implicated in the pathogenesis of cellulitis [25][26][27][28][29][30][31][32]. With the emergence of CA-MRSA, the role of this pathogen in these difficult-to-study infections is uncertain.…”

“…The positive yields of these techniques are variable and, overall, low [25][26][27][28]53], and as a result are not recommended.…”

“…However, in light of the emergence of CA-MRSA in purulent SSTI and the prominent role of MSSA in previous studies of cellulitis, empiric CA-MRSA coverage is recommended. Because streptococci have been shown to be another common cause of cellulitis [25][26][27][28]53], it is reasonable to include an agent or agents with in vitro activity against CA-MRSA and S. pyogenes.…”