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Guidelines
Non-Purulent Skin & Soft Tissue Infection

Non-Purulent Skin & Soft Tissue Infection

Empiric Treatment

Includes guidance for necrotizing infection / cellulitis / erysipelas

Pathogenic Organisms

Group A streptococcus
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Most common

Clinical Considerations

Failure to elevate extremity will delay clinical response or lead to clinical failure

Consider non-infectious cellulitis (dermatitis, lymphedema)

  • Cellulitis of the lower legs is almost always unilateral
  • Bilateral distribution of cellulitis only rarely occurs, usually because of an underlying condition, such as lymphoedema

Treatment

Mild Infection (Outpatient)
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No signs or symptoms of systemic infection

Moderate Infection
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Signs and symptoms of systemic infection:

  • Temperature >38°C
  • Tachycardia (heart rate >90 bpm)
  • Tachypnea (respiratory rate >24)
  • Abnormal WBC (>12,000 or <4000 cells/μL)
  • Immunocompromised patient

Severe Infection
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  • Signs and symptoms of systemic infection:
    • Temperature >38°C
    • Tachycardia (heart rate >90 bpm)
    • Tachypnea (respiratory rate >24)
    • Abnormal WBC (>12,000 or <4000 cells/μL)
    • Immunocompromised patient
  • Failed oral antibiotic

More Information

Dennis L. Stevens, Alan L. Bisno, Henry F. Chambers, E. Patchen Dellinger, Ellie J. C. Goldstein, Sherwood L. Gorbach, Jan V. Hirschmann, Sheldon L. Kaplan, Jose G. Montoya, James C. Wade, Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 59, Issue 2, 15 July 2014, Pages e10–e52, https://doi.org/10.1093/cid/ciu296