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  • cellulitis complication?

    Went to the ER with a hot red swollen lower leg and even a bit up in the groin. Diagnosis was cellulitis. Doppler studies were fine. Was on IV vancomycin for three days after which time swelling and redness had virtually disappeared and the physicians thought it was safe for me to go home and be on oral antibiotics (doxycycline) for another week.

    No sooner had I got home that night than the swelling, redness and heat had returned. At times it would get a little better, then worse. I'm beginning to think that perhaps the vancomycin kept the infection down, but once it was stopped the infection resumed. The oral antibiotic was supposed to be just a safeguard against recurrence, but is not to be capable of fighting the cellulitis if IV antibiotics couldn't. Today is day 2 after discharge. I've had no fever.

    I now have to have my primary care doctor look at it to give me his opinion and since it is the weekend if it gets worse I may need to go back to the emergency room, get readmitted and start the whole process over.

    I am praying that I do not have a problem with an antibiotic resistant organism.

    For any of you that have had cellulitis and were treated in the hospital did you have a recurrence shortly after discharge? Did the redness and swelling persist for a while afterwards?

    Thank you.

  • #2
    i took antibiotics for 6 weeks i think after being released but ya there was some swelling and redness when i left the hospital i think i was there 4 days
    to alcohol the cause of-and solution to-all of lifes problems [homer simpson]

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    • #3
      I've been on oral antibiotics for up to 2 months after hospital discharge for cellulitis, they were definitely to treat the infection and not just a safeguard like you mention. In my case I was usually discharged on at least 2 antibiotics and then weaned down to one until none. Thats going down from 3-4 different ones while hospitalized, but I can't take vancomycin so that may make a big difference.
      Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

      I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

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      • #4
        Vancomycin is like pulling out a cannon to shoot a duck. Any reason they put you on that? Besides the dangerous side effect of losing your hearing!

        In any case, 3 days doesn't seem long enough for a cellulitis that involved almost your entire leg. Ask to see an infection specialist, instead of just the ER doc next time. Any redness at all, I would go back immediately. That's a systemic infection.
        Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

        T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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        • #5
          There is simple cellulitis or first time then there is the chronic reoccurring cellulitis . Unless there is a wound of puncture area then Cellulitis is a combination of infection but the culprit or what might have started problem but definitely contributes to the reoccurrence is the edema or fluids accumulating. So if reoccurring and not healing, most of the time have to look at managing the edema and stop smoking, wear the special hose, and possibly if continues look at the vascular component i.e. Circulation( or lack of adequate blood flow and or drainage, no smoking, keep blood sugar and blood pressure under control, etc... Lymphedema (special wraps and treatment ) and what is term "elephantitis of legs".
          Bactrim, Doxycycline, Vancomycin best for skin infections.
          So important to stay on top of it as you re. And always rule out blood clot etc..
          CWO
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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          • #6
            Thanks for the prompt replies. It was better than the two attending physicians who never called me back and whose covering physician didn't know my case and wouldn't offer any advice other than to go to the ER if I felt so concerned.

            I did however reach my primary care physician who said that as long as the redness is not worsening or expanding and as long as there is no fever present, then there is no need to be alarmed at this time and run to the ER, so I will go to his office tomorrow and have him look at it in person.

            The major area affected was the foot, ankle and the lower leg almost up to the knee. I did have a little warmth and redness on my inner thigh high up near the groin but my entire leg wasn't on fire as by lower leg was. I did not have any open wound though my aide did say I had a small fissure in the web space between my small/next toe, typical of a minor foot condition. Though I take meticulous care of my feet and toes it is quite possible that this opening allowed bacteria in. I have also tried to control the edema, which was moderate but not severe, in my feet and legs through the use of a sequential compression pump that I have been using for close to 20 years to help move the fluids back up out of the feet and into the general circulation. One thing for sure is that the skin has been stretched very tight due to the swelling and one has to be careful once the swelling goes down as it is now more fragile than before. In addition, I always wear booties in the house and even when I am on the commode chair.

            Have any of you folks who have had it had a recurrence? Is there anything you were told to do to prevent its recurrence?

            Thanks once again for the information.

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            • #7
              I've had it 5 or 6 times over the last 15 or 16 years, and my doc gives me 10 500mg Keflex to keep on hand. As soon as I get redness with heat I take one and get in touch with him. I have 10 in case it happens on a weekend. I wear compression stockings every day, and seldom have a problem with edema, though the affected area does swell a bit.
              Don - Grad Student Emeritus
              T3 ASIA A 26 years post injury

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              • #8
                In my case I rush to get it looked at immediately, and draw a pen line around the red area on a daily basis to track the progression. The most recent time it started on a Friday night, I circled pen on Saturday, went in to an off hours walk in clinic Sunday, I'd been on antibiotics for uti when it started so they gave me different ones to take in addition, Wednesday I went to the er where I got another change of antibiotic and iv started, Thursday I was admitted when I returned to the er. The very first time it happened I didn't know what the big deal was, when I was sent to the er I kept repeating I'd been told to come because I felt it was a waste. Then was shocked at the seriousness of it all. It was a resistant infection that time as well so they started me off on iv vanco and I had multiple awful reactions, they didn't want to stop the iv drip and kept trying to give me other meds to get it under control for what felt like a lifetime. In my case the infections weren't even large patches of skin, small areas but grew rapidly and were unresponsive to multiple antibiotics. I see redness and warmth the size of a quarter and I'm circling it in pen to be safe.
                Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

                I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

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                • #9
                  Cellulits can recur if the original antibiotic was not the right one, or the duration of treatment insufficient. It can become a very serious septicemia if not properly managed. In addition, "flesh eating bacteria" can cause a very specific type of cellulitis (necrotizing fasciatis) which can be life threatening and lead to major loss of tissue (such as amputations).

                  In people with SCI and other paralyzing conditions (MS, etc.) we can't always identify the cause of the cellulitis. There may or may not be open wounds on the legs or even other parts of the body. Regardless, the cellulitis itself needs treatment.

                  If your symptoms return, you need to go back to the ER if you cannot immediately get in to see you provider.

                  (KLD)
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                  • #10
                    Last year I had pretty much the same thing as you. My foot ankle and lower leg up to the knee... I also had a little redness in my inner thigh but the infection specialist Dr. said that was not the infection spreading. He said that you have a lymph node (or something) there that was draining the infection and the redness was from that.

                    Like you, I didn't have any open wounds except for a small crack between my toes, so I assume that is where it started. Now I am paranoid about any little crack and I check between my toes every morning.

                    I first went to my Dr. on a Saturday when it was just my foot and ankle and he gave me some oral antibiotics and said if it gets any worse to call him. The next day, it was all the way up to my shin so he said to go to the hospital. When I went to the hospital they started me out on vancomycin which didn't work. The redness was still getting worse. They tried a couple other antibiotics before they found one that started to work so I was in the hospital for about a week. I can't remember the name of the antibiotic... Then once they had the antibiotic that worked, they put in a pic line and let me go home and give myself the IV antibiotics for the next couple of weeks.

                    Then the redness went away but for some reason my leg was still really swollen and the swelling wouldn't go down. So they sent me in to get an ultra sound and it turned out that I had a blood clot in my leg. So then I had the joy of injecting Heparin blood thinner into my own stomach. Then I was on Warfarin blood thinner pills for a while after that. You have to constantly go in for blood tests to make sure you are getting the correct dose.

                    The whole experience has turned me in to a bit of a germaphobe. but luckily I have not had any recurrence yet.

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                    • #11
                      I went through the same this past Fall. I was on I.V. vanco for five days for cellulitis that turned septic. The redness gradually went away over a two week period. Mine began from an open wound on my heal and it repeats to open. I keep either silversorb with a bandage on it or a silver alginate. I haven't had any problems with reinfection yet.

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                      • #12
                        Two months after my first episode of cellulitis ity recurred. Just got out of the hospital after six days of vancomycin, only this time more frequent dosing in 24 hours and a longer length of stay. Discharged with seven days of doxycycline, which my primary care doctor concurred on for duration. I still don't like the way the lower leg looks. My primary care doctor said a full recovery could take a while. There is no heat and minimal redness, however pretty substantial swelling. I use my intermittent compression pump/garments morning and evening to control the swelling. I am only in the chair, including bathroom activities, about six hours per day, not very much.

                        Having this occur so soon after the first case is pretty frightening and that I sure hope that they did not undertreat it this time as well. I am meticulous with my skincare, bathing, as well as skin protection for my feet. I never leave them exposed for they can be injured. Only a podiatrist cuts my toenails.

                        This definitely has me quite worried. And as bad as this was, having a Foley in during hospitalization was a nightmare. I have an augment and catheterize at home, but this is completely out of the question for the hospital setting. At least twice a day, sometimes more, the Foley would clog up, leading to at the very least voiding out the stoma, or at the worst, pretty serious autonomic hyperreflexia of my blood pressure up to about 150 from the normal of about 85. It had to be irrigated several times per day with no obvious signs of mucus clogs. The balloon and position was checked and I just don't know why I cannot drain reliably with a Foley anymore. The spasticity and deep pain was off the charts and it declined immeasurably once the Foley was removed.

                        At this point my urological problems, though not the reason for my hospitalization, always wind up being the cause for most of my nightmares in the hospital.

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                        • #13
                          After you are healed you may want to consider use of hibiclens (aka chlorhexadine) soap for skin cleaning like 3 times a week. I first saw a dermatologist recommend it for paraplegic who had recurrences of foliculitis that would then turn into an abscess. His skin area of infection was the buttocks happening because of skin shearing from sitting and shifting in his wheelchair cushion where it left his skin open to tiny skin tears. There are more research studies coming out that use of hibiclens in the hospital ICU unit is reducing the incidence in hospital acquired infections.

                          pbr
                          Last edited by SCI-Nurse; 04-03-2015, 10:17 PM.
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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                          • #14
                            Ever since my first episode I had been using hibiclens below both knees, as well as around my abdominal mitrofanoff stoma and perineal area with an eye towards reducing any surface bacteria on the skin which can penetrate microscopic breaks in my feet, as well as get carried in with a catheter. However, as much as I would like to do this with conviction, I remain concerned that it would just contribute to clorhexidine resistant bacteria. Such was the suggestion of my infectious disease physician as well, though he had no knowledge of controlled studies to prove or disprove such a belief. I do wash very well with plenty of soap and running water in the shower and disinfect the shower chair after every use with physician grade disinfectant known as envirocide, spraying the seat cushion, foot pedals, armrests, and backrest to prevent transmission to my skin from the chair.

                            Although my aide trimmed my toenails very carefully and well, that has been stopped as well and the only person to do so is my podiatrist.

                            I was even surprised to see that surgilube has the same active ingredient as Hibiclens in it, namely chlorhexidine gluconate.

                            Would you say that if I decide to use the Hibiclens that I should limit it to that region (i.e. below the knee) where I had cellulitis or use it more generally?

                            Thank you very much.

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                            • #15
                              Actually, we rarely are able to identify the source of the infection in our patients with cellulitis. Often there is no identifiable injury or open skin lesion anywhere on the body. We really don't know a lot of the time. It won't hurt you to use the Hibiclens as you describe, but it may not help either. The most important thing is to get medical attention immediately when you see signs of the cellulitis returning or occurring.

                              (KLD)
                              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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