Cellulitis: Management and Complications (Pediatric Nursing)

00:00 So how do we treat cellulitis? We use antibiotics. Now remember most of the Staph causes are methicillin-sensitive Staph aureus, but some of your patients will have methicillin-resistant Staph aureus or MRSA. There are some risk factors. In the last 6 months has your patient had MRSA or has a family member had MRSA and do they have a history of recurrent boils, pustules, "spider bites" and that's in quotes because most often when a patient presents with what they think is a spider bite it's actually an MRSA or MRSA'l lesion. You need to consider your patient's comorbidities. Is this a patient that can improve on orals or do they need to be watched closer in the hospital? And if your patient has an abscess, that needs to be managed and that's through an I&D or incision and drainage because this abscess pocket is encapsulated. The oral antibiotics will not cure an abscess, it has to be cut open and this is usually definitive treatment. The abscess in itself does not require antibiotic therapy unless the patient also has a surrounding cellulitic infection. You want to carefully inspect the skin around the abscess. And these conditions are painful so you want to provide your patient with pain relief and if it's on an extremity they should elevate. So how do we manage cellulitis? It's important to recognize it early because untreated cellulitis can lead to sepsis and death.

01:26 You can use the following guidelines for empiric antibiotic therapy. So if you have an outpatient and they have non-purulent cellulitis you can empirically treat for beta-hemolytic Strep. Some clinicians choose an agent that's also effective against Staph aureus. For outpatient management with purulent cellulitis which means there is a drainage, you're going to cover for MRSA or methicillini-resistant Staph aureus. Now for unusual exposures, you want to cover for additional bacterial species that could be involved including if the wound was caused by an animal bite such as a dog or a cat then the cellulitis would require treatment that would cover the animal's oral flora. When you're managing cellulitis, you want to have your patients on your radar. They need close follow-up and this is when you would change treatment as indicated. You want to do strict teaching about red flags and these are the signs of worsening.

02:21 Patients are always wondering when will their cellulitis get better. Well, this can take a few days and this is an important education point. You can see on day 1 only 50% of patients started on antibiotics will have a cessation of the spread and improved inflammation and only 40% will have defervescence so improvement of their fever and decreased white blood cell count. You can see on day 2 more of the patients start to improve but it's not until day 3 that we see a real improvement. So I'm sure to warn my patients that they won't see any improvement for 2-3 days. Be sure to give them enough reassurance and close follow-up.

02:58 I will call my patients the next day and even the next day, see how they're doing and if I'm really worried I will invite them back to the clinic so I can look at their wound and also check their vital signs. So there are complications to cellulitis. Your patient's cellulitic infection can also form an abscess and remember this requires different treatment. Your patient can develop necrotizing fasciitis and this is serious. This is a flesh-eating disease that spreads rapidly. Your patient will develop red and purple skin, severe pain, fever, and vomiting. These are really sick patients and this requires aggressive surgical debridement and antibiotics.

03:35 So, I've had patients present with small cellulitc regions on day 1 and within 12 hours they have rapidly decompensated. They develop a fever, tachycardia, and signs of shock and these are the patients with necrotizing fasciitis. They need to go immediately to the hospital and typically be managed in the operating room with a surgical specialist. If not treated, this can progress to sepsis and death.