chapter  26
Cellulitis and necrotizing fasciitis
WithVikas Pathania
Pages 6

Skin and soft tissue bacterial infections often present as a dermatological emergency either directly to the dermatologist at the emergency department or more commonly in inpatients as cross-referrals. Cellulitis and erysipelas are essentially acute infection and inflammation of the dermis and the subcutaneous connective tissue and are grouped together as nonnecrotizing skin and soft tissue infections. Necrotizing skin and soft tissue infections include necrotizing fasciitis, gangrenous cellulitis, and myonecrosis and are characterized by being locally destructive and spreading via tissue planes. They are often associated with serious systemic complications. Group Aβ hemolytic streptococci and Staphylococcus aureus are the two bacteria that are most commonly implicated; however, other groups of streptococci, coagulase-negative Staphylococcus aureus, as well as Haemophilus influenzae, Vibrio vulnificus, and Enterococcus have been isolated in special situations and age groups. The rise of methicillin-resistant Staphylococcus aureus has further contributed to the incidence as well as morbidity and mortality arising from these infections. Herein lies the importance of early and emergent clinical diagnosis and institution of empirical antibiotics with or without surgical intervention.