Cellulitis/Abscess Clinical Pathway — Emergency Department and Inpatient

Skin Infections: Definitions and Organisms

Condition		Definition	Organism
Impetigo Bullous, Non-bullous		Erythematous papules that rapidly evolve into vesicles or pustules that rupture, forming honey-colored crust or an erythematous erosion surrounded by a collar of the roof’s remnant	Group A Streptococcus (S. pyogenes) Staphylococcus aureus (more often MSSA than MRSA) Ecthyma may also by caused by P. aeruginosa in neutropenic hosts
Ecthyma		Superficial dermal infection, circular, erythematous ulcers with adherent crust, often with surrounding erythematous edema
Purulent Skin and Soft Tissue Infection	Folliculitis	Superficial infection of the hair follicle, limited to the epidermis	Staphylococcus aureus (often MRSA)
	Furuncle	Deeper infection of the hair follicle Usually caused by S. aureus Suppuration extends through the dermis into the subcutaneous tissues, small abscess forms
	Carbuncle	Infection of several adjacent hair follicles Pus drains from multiple follicle sites Most common on back, neck
	Cutaneous Abscess	Collection of pus in the dermis and deeper tissues, often surmounted with a pustule encircled by rim of erythematous swelling
Non-purulent Cellulitis	Erysipelas	Infection limited to the epidermis including the superficial lymphatics, tender, intensely erythematous with a sharply demarcated border	Group A Streptococcus (S. pyogenes) Infrequently caused by S. aureus except in cases of penetrating wounds
Non-purulent Cellulitis	Cellulitis	Infection involving the deep dermis and subcutaneous fat
Necrotizing Fasciitis		Aggressive subcutaneous infection that tracks along the superficial fascia, often extending from the skin lesion producing “wooden-hard induration” of the subcutaneous tissue	S. pyogenes most common monomicrobial cause Other pathogens include: S. aureus V. vulnificus A. hydrophila Anaerobic streptococci May be polymicrobial, and specific organisms depend on location and exposures Discuss with ID and surgery if suspected

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Cellulitis/Abscess Clinical Pathway — Emergency Department and Inpatient

Skin Infections: Definitions and Organisms

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Cellulitis/Abscess — Skin Infections: Definitions and Organisms — Clinical Pathway: Emergency Department and Inpatient

Cellulitis/Abscess Clinical Pathway — Emergency Department and Inpatient

Skin Infections: Definitions and Organisms