Vanderbilt Physician Diagnoses Serious Infection with VisualDx

Henry, a physician at Vanderbilt University Medical Center, shares how he used VisualDx to identify his patient’s infection.

“We had a patient come in for congestive heart failure. As we treated him, he developed leukocytosis and began complaining of hand pain where his IV site was. His IV was then moved to his upper arm and his hand was bandaged, but he still complained of pain. When we looked at his hand later, it was erythematous, warm, painful, and limited his range of motion. Using the VisualDx app, we were able to diagnose him with cellulitis and begin appropriate pharmacotherapy.”

What is cellulitis?

Cellulitis is an infection of the skin and is most often caused by the bacteria Streptococcus or Staphylococcus. These bacteria are able to enter the skin through small cracks, causing the sudden appearance of redness, swelling, and warmth in the skin. Cellulitis is sometimes accompanied by fever, chills, and general fatigue.

If the infection is left untreated for too long, cellulitis can result in abscesses or bacteremia. However, most cases of cellulitis resolve with appropriate antibiotic therapy.

What should we be aware of when making a diagnosis?

Recurring infection can be due to damaged lymphatics. Check carefully for a portal for recurring bacterial “seeding,” underscoring the importance of detecting and treating concomitant toe web abnormalities.

Distinguishing cellulitis from necrotizing fasciitis is also critical because necrotizing fasciitis requires immediate surgical intervention for source control.

How can we treat this?

• Empiric antibiotic choice should be guided by immune status, MRSA risk factors, and purulence. It is helpful to be aware of patterns of antimicrobial resistance within your community. In general, methicillin-sensitive S aureus (MSSA) and streptococcal coverage is adequate, eg, cephalexin or penicillins.
• Choose intravenous antibiotics for patients with more than 2 systemic inflammatory response syndrome (SIRS) criteria and use broad coverage if patient is systemically unwell. For patients with true penicillin allergy, use clindamycin.
• Refer to VisualDx Antimicrobial Stewardship Resources for patient and physician information on principles of appropriate antibiotic prescribing and use.