Article for Site Evaluation

Title: Diagnosis and Management of Cellulitis and Abscess in the Emergency Department Setting: An Evidence-Based Review

Study Type: Review

Publication: The Journal of Emergency Medicine (Published January 2022.)

Authors: Brit Long and Michael Gottlieb

Reason for selection: I chose this article in relation to my third H&P. I decided that I wanted to focus on a review of the concepts behind Abscess and Cellulitis formation. I also wanted to review the tools and techniques that can be used to differentiate one from the other in patients that present with skin changes.

Abstract:

Background: Cellulitis and abscess are common reason for presentation to the emergency department, although there are several nuances to the care of these patients.

Objective: The purpose of this narrative review article was to provide a summary of the background, pathophysiology, diagnosis, and management of cellulitis and abscesses with a focus on emergency clinicians.

Discussion: The most common bacteria causing cellulitis are Staphylococcus aureus, Streptococcus pyogenes, and other β-hemolytic streptococci, and methicillin-resistant S. aureus is most common in abscesses. The history and physical examination are helpful in differentiating cellulitis and abscess in many cases, and point-of-care ultrasound can be a useful tool in unclear cases. Treatment for cellulitis typically involves a penicillin or cephalosporin, and treatment of abscesses is incision and drainage. Loop drainage is preferred over the traditional incision and drainage technique, and adjunctive antibiotics can be considered. Most patients can be managed as outpatient.

Conclusions: It is essential for emergency physicians to be aware of the current evidence regarding the diagnosis and management of patients with cellulitis and abscess.

General Summary of the Article: 

Cellulitis is a skin infection that occurs after bacteria invade the skin barrier and an abscess is a soft tissue infection that also occurs after bacteria find a port of entry such as through wounds and a breach in the skin barrier. B-hemolytic streptococci and Staph aureus are more commonly found in non-purulent cellulitis. On the other hand, Staph aureus is the most common microbe in abscesses with up to 70% being MRSA. Abscesses are associated with erythema, fluctuance, pyogenic material, and induration however, in some cases if the erythema and induration spread past the abscess margin it might suggest more of purulent cellulitis.

Patients with cellulitis usually present with unilateral pain, warmth, edema, tenderness, and erythema and may develop over several days (usually affects lower limbs and the involvement is typically circumferential). As seen in my case antibiotics are employed in treating cellulitis but in an abscess, I&D is the tx of choice.