From the Guidelines
The most common causative organisms of cellulitis in patients with type 2 diabetes are Streptococcus species, particularly group A streptococci, and Staphylococcus aureus, with empiric treatment recommended to cover these pathogens 1, 2. When considering the management of cellulitis in diabetic patients, it's essential to prioritize the most recent and highest quality evidence. The 2014 update by the Infectious Diseases Society of America provides strong, moderate recommendations for the diagnosis and management of skin and soft tissue infections, including cellulitis 2. Key points to consider in the management of cellulitis in diabetic patients include:
- Empiric antibiotic therapy should cover Streptococcus species and Staphylococcus aureus, with options including cephalexin or amoxicillin-clavulanate for mild to moderate cases 2.
- For patients with suspected MRSA, consider using trimethoprim-sulfamethoxazole or clindamycin 2.
- Severe cases may require hospitalization and intravenous antibiotics like vancomycin, ceftriaxone, or piperacillin-tazobactam 2.
- Maintaining good glycemic control is crucial during treatment, as elevated blood glucose levels can impair immune function and slow healing 1.
- Regular wound care, elevation of the affected limb, and close monitoring for signs of worsening infection are essential components of management 1, 2.
- If there's no improvement within 48-72 hours of starting antibiotics, reassessment and possibly culture-guided therapy should be considered 1, 2. It's also important to note that diabetic patients are more susceptible to cellulitis due to impaired immune function, neuropathy, and vascular insufficiency, which can delay healing and increase infection risk 1. Therefore, the recommended empiric treatment for cellulitis in diabetic patients is cephalexin 500 mg orally four times daily for 5-7 days, with adjustment based on clinical response and culture results, if available 2.
From the Research
Organism for Cellulitis in Type 2 Diabetes
- The most common organisms responsible for cellulitis are β-hemolytic Streptococcus and Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA) 3.
- In patients with type 2 diabetes, the prevalence of MRSA in infected foot ulcers is significant, with one study showing a prevalence of 34% 4.
- Diabetes is a major predisposing factor for cellulitis, along with obesity and old age, due to defects in the physical skin barrier, immune system, and circulatory system 5.
- The treatment of cellulitis in patients with type 2 diabetes should cover Streptococcus and methicillin-sensitive S. aureus, with consideration for MRSA coverage in cases with specific risk factors 3, 6.
- Clinical success rates for treating cellulitis are lower in diabetic patients compared to non-diabetic patients, highlighting the need for careful management and consideration of underlying conditions 7.