Spectrum: Local Antimicrobial Stewardship, for Island Health

SSTI: Initial Failure?

Wrong Bug

Consider early zoster

  •  Dermatomal distribution?

  •  Vesicles?

  •  Pain?

Consider risk factors for gram negative cellulitis or MRSA

Gram Negative Cellulitis RFs

Injury occurring in water

  • Fresh water - Aeromonas

  • Salt water - Vibrio spp.

Penetrating injury with foreign body

  •  e.g. Nail through shoe

Diabetic foot infection

Immunocompromise

MRSA Risk Factors

Previous MRSA colonization/infection

Hospital Acquired
dialysis patient,
nursing home residence,
hospitalization in past 90 days,
MRSA outbreak setting

Community Acquired

  • Known contact (i.e. household member has MRSA)

  • Homelessness

  • Incarceration

  • First Nations

Does the patient have other risk factor for unusual pathogens?

  • Animal exposure

  • Travel

  • Hobbies

  • etc.

Wrong Diagnosis

Superficial thrombophlebitis or deep venous thrombosis

Venous stasis dermatitis

Gout

Wrong Duration

Cellulitis associated with venous stasis can be very slow to resolve.

Source Control

Consider abscess, retained foreign body, or deeper infection such as osteomyelitis/septic joint

Other DDx Considerations

Contact dermatitis, foreign body reaction

Insect bite - venom reaction

Fixed drug reaction

Pyoderma gangrenosum

Sweet Syndrome

Eosinophilic cellulitis

Hidradenitis suppurativa

Malignant