Type of infection |
Description |
Common Gram-negative microbial pathogens |
Population at risk |
Echthyma gangrenosum |
Cutaneous infection that causes hemorrhagic pustules and evolves into a necrotic ulcer |
Pseudomonas spp., Stenotrophomonas maltophilia, Enterobacteriaceae |
Immunocompromised, malignancy, critically ill |
Cellulitis |
Acute infection of the skin and subcutaneous tissue that results in erythema, warmth, swelling and tenderness, with possible bullae or systemic symptoms (leukocytosis, fever) |
Pseudomonas aeroginosa, Enterobacteriaceae |
Previous antibiotic exposure, prolonged hospitalization |
Cellulitis in special situations |
Cellulitis, can present with ulceration, myonecrosis or rhabdomyolysis |
Aeromonas spp. |
Traumatic freshwater injury, cirrhosis, diabetes, immunocompromised |
|
Mild cellulitis, can progress rapidly with bullae, severe myonecrosis, or nectrotizing fasciitis in high-risk individuals |
Vibrio vulnificus |
Traumatic injury with saltwater, shellfish, or fish, cirrhosis, hereditary hemochromatosis, diabetes |
|
Cellulitis with possible cutaneous abscesses |
Enterobacteriaceae, Pseudomonas aeroginosa, usually polymicrobial |
Intravenous drug use |
|
Metastatic cellulitis – tender, erythematous, warm subcutaneous infiltrates that can be well demarcated |
S. maltophilia |
Immunocompromised, catheter and device placement |
Necrotizing fasciitis |
Rapidly progressive inflammation of the fascia, with secondary necrosis of the subcutaneous tissue characterized by erythema, fever and pain out of proportion to skin manifestations |
Polymicrobial (Enterobacteriaceae, Pseudomonas aeroginosa) |
More common in abdomen or groin (Fournier's gangrene), diabetes, obseity, or immunodeficiency |
Diabetic foot infections |
Differentiated from uninfected ulcer, usually warm, erythematous, swollen, increasing exudate or pus, inflammatory changes within ulcer bed, could include pain or systemic signs (fever, leukocytosis) |
Polymicrobial (Enterobacteriaceae, Pseudomonas spp.) |
Uncontrolled diabetes, peripheral vascular disease, chronic wounds, antibiotic exposure |
Infected pressure ulcers |
Differentiated from uninfected ulcer, could present with new or worsening pain, clinical signs of fever and inflammation |
Polymicrobial (Pseudomonas spp., Enterobacteriaceae commonly Proteus mirabilis, Acinetobacter spp.) |
Patients in long-term facilities or prolonged hospital stay |
Surgical site infections |
Infection of a surgical site with signs of erythema, inflammation, pain, purulent drainage, possible systemic symptoms (fever, leukocytosis) |
Enterobacteriaceae, Acinetobacter, Pseudomonas spp. |
Operations on the axilla, gastrointestinal tract, perineum, or female genital tract |
Burn wound infection |
May be difficult to distinguish burn wound infection from noninfectious burn erythema, can be confirmed with tissue biopsy |
Pseudomonas spp., S.maltophilia, Acenitobacter spp., Enterobacteriaceae |
Severe burn injury, prior antibiotic exposure, Gram-negative colonization |
Injury in war |
Increasing pain, erythema, or discharge from the wound, can be associated with systemtic symptoms (fever, hemodynamic instability) |
Pseudomonas spp., A. baumannii, Enterobacteriaceae |
Chronic war traumatic wounds, embedded foreign material |
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