Risk Factors for Community-associated Methicillin-resistant Staphylococcus Aureus Cellulitis - and the Value of Recognition

Objectives

To identify the risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) cellulitis.

Methods

A review of risk factors for CA-MRSA skin and soft tissue infection in previously published literature was first performed. A retrospective cohort study was then conducted in a teaching ambulatory-care clinic of a tertiary medical center in Honolulu, Hawai‘i.

Results

Of 137 cases with cellulitis diagnosed from January 2005 to December 2007, MRSA was recovered from 85 (62%) of patients who presented with either abscesses or skin ulcers. The recovery of MRSA was significantly associated with obesity (p=0.01), presence of abscesses (p=0.01), and lesions involving the head and neck (p=0.04). Independent risk factors by multivariate logistic regression analysis included the presence of abscesses [adjusted odds ratio (aOR) 2.72; 95% confidence interval (CI) 1.27–5.83; p=0.01] and obesity (aOR 2.33; 95% CI 1.10–4.97; p =0.03). Patients with CA-MRSA were less likely to receive an appropriate antibiotic (p=0.04) and were more likely to require antibiotic change at evaluation in one week (p=0.04) compared with patients infected with non-MRSA bacteria.

Conclusions

The presence of abscesses and obesity were significantly associated with CA-MRSA cellulitis. Empiric therapy with antibiotics active against MRSA should be guided by these risk factors.

NIH

Imaging in infections of the head and neck.

Nov 2012

Hegde AN, Mohan S, Pandya A, Shah GV.

Source

Department of Radiology, Singapore General Hospital, Block 4, Level 1, Outram Rd, Singapore 169608. Electronic address: amogh77@yahoo.co.in.

Abstract

Infections of the head and neck vary in their clinical course and outcome because of the diversity of organs and anatomic compartments involved. Imaging plays a central role in delineating the anatomic extent of the disease process, identifying the infection source, and detecting complications. The utility of imaging to differentiate between a solid phlegmonous mass and an abscess cannot be overemphasized. This review briefly describes and pictorially illustrates the typical imaging findings of some important head and neck infections, such as malignant otitis externa, otomastoiditis bacterial and fungal sinusitis, orbital cellulitis, sialadenitis, cervical lymphadenitis, and deep neck space infections.

Elsevier

The use of ultrasonography in diagnosis and management of superficial fascial space infections.

May 2012

Mukhi PU, Mahindra UR.

Source

Department of Oral and Maxillofacial Surgery, S.M.B.T Dental College and Hospital, Amrutnagar, Sangamner, Maharashtra, India.

Abstract

Aims and Objectives: To evaluate the role of ultrasonography as a diagnostic aid to differentiate cellulitis from abscess; and efficacy of ultrasound-guided surgical drainage of superficial abscesses in the maxillofacial region. 

Materials and Methods: a total of 26 patients with acute facial swellings were included in the study. Clinical examination confirmed the presence of space infection. Ultrasonographic examination of the swelling was then performed. If ultrasound images showed no collection and only thickness of subcutaneous tissue and muscle involved were increased, then the diagnosis was made as cellulitis. When collection was identified, diagnosis was made as abscess. Dimensions of abscess cavity, amount of pus collected, and depth of the center of the abscess cavity from the skin surface were recorded. Pus evacuation was then prime consideration either by needle aspiration or by incision and drainage. The amount of collection recorded on ultrasonography was compared with that drained at the time of surgery. 

Results: of 26 patients, 14 patients were diagnosed with cellulitis and the remaining 12 patients with abscesses in the maxillofacial region. Five of 12 cases of abscess were managed with ultrasound-guided needle aspiration; rest seven cases underwent the incision and drainage procedure. Clinical specificity (69.23%) was found to be poorer than ultrasound specificity (100 %), both clinical and ultrasound showed the same percentage of sensitivity (92.30%) 

Conclusions: from our experience we can conclude that ultrasonography is an inexpensive and non-invasive diagnostic technique that should be used to supplement clinical examination in patients with superficial fascial space infection.

PubMed