Practical Practitioner

By: Pamela Egan, FNP-C CDE

Cellulitis caused when bacteria spread to tissue under the skin

Dear Pam,

Could you write about “cellulitis”? My son is 40 years old, and we have gone to the emergency room several times. His hands, arms and feet puff up and discolor. Last time he was given a strong IV antibiotic and released.

Cellulitis is a skin infection caused by bacteria. The infection most often develops anywhere the skin has been broken- often from a cut, burn or an insect bite. The infection spreads from the skin to underlying tissues.

In severe cases, it can spread quickly, within hours or days.

Cellulitis is caused by bacteria, usually Streptococcus pyogenes or Staphylococcus aureus bacteria. Some people with impaired immune systems are at risk for infection by other types of bacteria that result in cellutitis.

Cellulitis can cause tenderness, pain, swelling and redness at the site of the infection. Fever and chills are also common. Cellulitis can occur anywhere on the body. In adults, it often occurs on the legs, face or arms.

Staphylococcus aureus, often referred to simply as “staph,” are bacteria commonly carried on the skin or in the nose of healthy people. Staph bacteria are one of the most common causes of skin infections in the United States. Most of these infections are minor (such as pimples and boils). Staph bacteria can also cause serious infections (such as surgical wound infections and pneumonia).

In the past, most serious staph bacterial infections were treated with a certain type of antibiotic related to penicillin.

Over the past 50 years, treatment of these infections has become more difficult because staph bacteria have become resistant to various antibiotics, including the commonly used penicillin-related antibiotics. These resistant bacteria are called methicillin resistant Staphylococcus aureus, or MRSA.

Staph bacteria and MRSA can be found on the skin and in the nose of some people without causing illness. Infection occurs when the staph bacteria cause disease in the person.

MRSA infection usually develops in hospitalized patients who are elderly or very sick or who have an open wound or tube going into their body.

Complications such as bacteremia (presence of bacteria in the blood) or sepsis can develop if the bacteria spreads quickly through the body.

There is an increase of MRSA causing illness in persons outside of hospitals. Staph bacteria and MRSA can spread among people having close contact with infected people. MRSA is almost always spread by direct physical contact by touching objects (towels, sheets, wound dressings, clothes, workout areas, sports equipment) contaminated by the infected skin of a person with MRSA or staph bacteria. Brown recluse spider bites often cause MRSA infections.

Has your son been checked for diabetes?

Diabetes and peripheral vascular disease can also increase risk for complications. It is also important to practice good hygiene.

Keep you hands clean by washing thoroughly with soap and water. Keep cuts and abrasions clean and covered with a proper dressing until healed. Avoid contact with other people’s wounds or material contaminated from wounds.

Antibiotics are the main treatment for cellulitis and are usually successful in curing the infection. For recurrent episodes of cellulitis, an Infectious Disease Specialist should be consulted.

This article was originally published March 22, 2004 in The St. Tammany News.

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