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Cellulitt

Sist oppdatert: Sist revidert:
Sist revidert av:

Definisjon:
Cellulitt er en akutt infeksjon i hud og underhud
Forekomst:
Vanlig i allmennpraksis og ved sykehus
Symptomer:
Lokalisert erytem og varme, moderate smerter, tidvis hudblødninger, bullae og ofte allmennsymptomer
Funn:
Uskarpt avgrenset erytem, inhomogen farge, satelitter, lesjoner
Diagnostikk:
Anamese og klinisk undersøkelse
Behandling:
Antibiotika, elevasjon, kompresjon - ev. eksplorasjon ved mistanke om dypere eller alvorligere infeksjoner. Behandle disponerende faktorer om aktuelt
  1. Stevens DL, Bisno AL, Chambers HF. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59: 10. pmid:24973422 PubMed  
  2. Bruun T, Oppegaard O, Kittang BR, et al. Etiology of Cellulitis and Clinical Prediction of Streptococcal Disease: A Prospective Study. Open Forum Infect Dis. 2015 Nov 25;3(1):ofv181. PMID: 26734653. PubMed  
  3. Cranendonk DR, Lavrijsen APM, Prins JM, Wiersinga WJ. Cellulitis: current insights into pathophysiology and clinical management. Neth J Med. 2017 Nov;75(9):366-378. PMID: 29219814. PubMed  
  4. Chambers HF. Cellulitis, by any other name. Clin Infect Dis. 2013 Jun;56(12):1763-4. Epub 2013 Mar 1. PMID: 23457076. PubMed  
  5. Oppegaard O, Mylvaganam H, Kittang BR. Beta-haemolytic group A, C and G streptococcal infections in Western Norway: a 15-year retrospective survey. Clin Microbiol Infect. 2015 Feb;21(2):171-8. Epub 2014 Oct 14. PMID: 25658557. PubMed  
  6. Cannon J, Rajakaruna G, Dyer J, Carapetis J, Manning L. Severe lower limb cellulitis: defining the epidemiology and risk factors for primary episodes in a population-based case-control study. Clin Microbiol Infect. 2018 Oct;24(10):1089-1094. Epub 2018 Feb 7. PMID: 29427797. PubMed  
  7. DiNubile MJ, Lipsky BA. Complicated infections of skin and skin structures: when the infection is more than skin deep. J Antimicrob Chemother 2004; 53: 37. pmid:15150182 PubMed  
  8. McNamara DR, Tleyjeh IM, Berbari EF. Incidence of lower-extremity cellulitis: a population-based study in Olmsted county, Minnesota. Mayo Clin Proc 2007; 82: 817. pmid:17605961 PubMed  
  9. Jeng A, Beheshti M, Li J, Nathan R. The role of beta-hemolytic streptococci in causing diffuse, nonculturable cellulitis: a prospective investigation. Medicine 2010; 89: 217-26. PubMed  
  10. Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas. J Infect. 2012 Feb;64(2):148-55. Epub 2011 Nov 11. PMID: 22101078. PubMed  
  11. Karakonstantis S. Is coverage of S. aureus necessary in cellulitis/erysipelas? A literature review. Infection. 2020 Apr;48(2):183-191. Epub 2019 Dec 16. PMID: 31845187. PubMed  
  12. Vinh DC, Embil JM. Rapidly progressive soft tissue infections. Lancet Infect Dis 2005; 5: 501. pmid:16048719 PubMed  
  13. Eron LJ, Lipsky BA. Use of cultures in cellulitis: when, how, and why?. Eur J Clin Microbiol Infect Dis 2006; 10: 615. pmid:16896821 PubMed  
  14. Rath E, Skrede S, Oppegaard O, Bruun T. Non-purulent skin and soft tissue infections: predictive power of a severity score and the appropriateness of treatment in a prospective cohort. Infect Dis (Lond). 2020 May;52(5):361-371. Epub 2020 Feb 13. PMID: 32052670. PubMed  
  15. Gottlieb M, Avila J, Chottiner M, et al. Point-of-Care Ultrasonography for the Diagnosis of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-analysis. Ann Emerg Med. 2020 Feb 17. pii: S0196-0644(20)30004-4. doi: 10.1016/j.annemergmed.2020.01.004. Pmid: 30119943.
  16. Ko LN, Garza-Mayers AC, St John J, et al. Clinical Usefulness of Imaging and Blood Cultures in Cellulitis Evaluation. JAMA Int Med 2018. doi:10.1001/jamainternmed.2018.0625 DOI  
  17. Swartz MN. Cellulitis. N Engl J Med 2004; 350: 904-12. PubMed  
  18. Akselsen PE. Erysipelas og cellulitt. Lindbæk M (red). Nasjonale faglige retningslinjer for antibiotikabruk i primærhelsetjenesten. Oslo: Helsedirektoratet. Sist oppdatert 16.06.2020. Siden lest 15.01.2021. www.antibiotikaiallmennpraksis.no  
  19. Rath E, Skrede S, Mylvaganam H, Bruun T. Aetiology and clinical features of facial cellulitis: a prospective study. Infect Dis (Lond). 2018 Jan;50(1):27-34. Epub 2017 Aug 2. PMID: 28768452. PubMed  
  20. Helsedirektoratet (2021). Nasjonal faglig retningslinje for antibiotika i primærhelsetjenesten nettdokument. Oslo: Helsedirektoratet (sist faglig oppdatert 16. november 2021, lest jan 2022).
  21. Williams OM, Brindle R. Antibiotic route and duration of therapy for cellulitis: data extracted from a multi-center clinical trial. Int J Antimicrob Agents. 2020 Sep;56(3):106076. Epub 2020 Jul 3. PMID: 32629112. PubMed  
  22. Brindle R, Williams OM, Davies P, et al. Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis. BMJ Open. 2017 Mar 17;7(3):e013260. PMID: 28314743. PubMed  
  23. Nasjonal faglig retningslinje for Antibiotika i sykehus. Cellulitt. Sist faglig oppdatert 08.01.2018. Siden lest 31.01.2022 www.helsedirektoratet.no  
  24. Webb E, Neeman T, Bowden FJ, Gaida J, Mumford V, Bissett B. Compression Therapy to Prevent Recurrent Cellulitis of the Leg. N Engl J Med. 2020 Aug 13;383(7):630-639. PMID: 32786188 PubMed  
  25. Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. New Engl J Med 1996; 334: 240. doi:10.1056
  26. Brindle, R.J., O’Neill, L.A. & Williams, O.M. Risk, Prevention, Diagnosis, and Management of Cellulitis and Erysipelas. Curr Derm Rep 9, 73–82 (2020). doi: 10.1007/s13671-020-00287-1.
  27. Oppegaard O, Skrede S, Mylvaganam H, Kittang BR. Emerging Threat of Antimicrobial Resistance in β-Hemolytic Streptococci. Front Microbiol. 2020 May 15;11:797. PMID: 32477287. PubMed  
  28. Cranendonk DR, Opmeer BC, van Agtmael MA et al. Antibiotic treatment for 6 days versus 12 days in patients with severe cellulitis: a multicentre randomized, double-blind, placebo-controlled, non-inferiority trial. Clin Microbiol Infect. 2020 May;26(5):606-612. Epub 2019 Oct 13. PMID: 31618678. PubMed  
  • Eivind Rath, indremedisiner og infeksjonslege, Haukeland Universitetssjukehus, Bergen

Tidligere fagmedarbeidere

  • Bjørn Waagsbø, overlege avdeling for infeksjonssykdommer, St Olavs Hospital, Trondheim