From the Guidelines
Infectious diseases specialist consultation is crucial for cellulitis cases with severe or rapidly progressing infections, lack of improvement after 48-72 hours of appropriate antibiotic therapy, or frequent recurrence, as well as in patients with significant comorbidities or complicated treatment scenarios, such as diabetes, immunosuppression, or peripheral vascular disease. The decision to consult a specialist should be based on the severity of the infection, the patient's overall health status, and the potential for complications. According to the practice guidelines for the diagnosis and management of skin and soft tissue infections updated by the Infectious Diseases Society of America in 2014 1, consultation is recommended for patients with severe infections, those who do not respond to initial treatment, or when there is uncertainty about the diagnosis or management.
Some key scenarios where specialist consultation is warranted include:
- Severe or rapidly progressing infections
- Lack of improvement after 48-72 hours of appropriate antibiotic therapy
- Frequent recurrence of cellulitis
- Significant comorbidities such as diabetes, immunosuppression, or peripheral vascular disease
- Unusual locations of infection, such as facial or periorbital cellulitis
- Suspected necrotizing infections or those requiring surgical intervention
- Uncertainty about the diagnosis or when the infection appears to be healthcare-associated or involves resistant organisms
- Patients with significant drug allergies limiting treatment options
The specialist can provide expertise in identifying unusual pathogens, recommending appropriate antimicrobial therapy, determining the need for surgical intervention, and managing complex cases that may require prolonged or specialized treatment approaches, as outlined in the guidelines 1. Their involvement often leads to more targeted therapy, potentially reducing complications and improving outcomes in challenging cases.
From the Research
Indications for Consulting Infectious Diseases Specialist for Cellulitis
The decision to consult an infectious diseases specialist for cellulitis depends on several factors, including:
- Severity of the infection
- Presence of comorbidities or underlying conditions
- Failure to respond to initial treatment
- Presence of signs of sepsis or systemic infection
- Uncertainty in diagnosis or need for further evaluation
Specific Scenarios for Consultation
The following scenarios may warrant consultation with an infectious diseases specialist:
- Patients with recurrent episodes of cellulitis 2
- Patients with underlying conditions such as venous insufficiency, lymphedema, or immunosuppression 2
- Patients who have failed to respond to initial antibiotic treatment 3
- Patients with signs of sepsis or systemic infection 2
- Patients with uncertain diagnosis or need for further evaluation, such as distinguishing cellulitis from other dermatologic conditions 4, 3
Benefits of Infectious Diseases Specialist Consultation
Consultation with an infectious diseases specialist has been shown to improve outcomes for patients with cellulitis, including: