Glennon Colleen M, El Saleeby Chadi, Kroshinsky Daniela
Department of Dermatology, Duke University School of Medicine, 307 Research Drive, Durham, NC, 27710, USA.
Divisions of Pediatric Infectious Disease and Pediatric Hospital Medicine, Mass General for Children, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Am J Clin Dermatol. 2025 Apr 21. doi: 10.1007/s40257-025-00936-w.
Cellulitis, a bacterial skin infection most frequently caused by group A streptococci (Streptococcus pyogenes) and less so by Staphylococcus aureus, commonly occurs in pediatric patients. The non-specific clinical presentation of poorly demarcated, expanding erythema, and warmth is common to a multitude of similarly presenting conditions, contributing to challenges in accurate diagnosis. There is also no gold standard diagnostic test for cellulitis, as laboratory assessments, tissue and blood cultures, and imaging studies have not been helpful. These adjunctive studies may be useful, however, for ruling out mimickers or more serious or complicating conditions, such as osteomyelitis, necrotizing fasciitis, or abscess. Diagnosis remains largely clinical and evaluation by a dermatologist and/or infectious disease specialist continues to be the clinical gold standard. As a result, access to specialty care and further research into helpful adjunctive measures, such as thermal imaging, are imperative for accurate diagnosis and management to prevent inappropriate antibiosis. Multidrug resistance has continued to evolve since the initial emergence of community-associated methicillin-resistant Staphylococcus aureus, with more recent studies showing an overall decline of methicillin-resistant S. aureus in the community and highest rates remaining in the Southern region of the USA. Despite changing resistance patterns, inappropriate prescribing patterns have persisted and contribute to rising rates of resistance to antibiotics such as trimethoprim-sulfamethoxazole and clindamycin. Therefore, accurate diagnosis and subsequent management with the narrowest possible antimicrobial therapy is ideal both for individual patient outcomes and for public health.
蜂窝织炎是一种细菌性皮肤感染，最常见的病因是A组链球菌（化脓性链球菌），其次是金黄色葡萄球菌，常见于儿科患者。界限不清、不断扩大的红斑和发热等非特异性临床表现常见于多种类似病症，这给准确诊断带来了挑战。目前也没有用于蜂窝织炎的金标准诊断测试，因为实验室评估、组织和血液培养以及影像学检查都没有帮助。然而，这些辅助检查可能有助于排除类似疾病或更严重或复杂的病症，如骨髓炎、坏死性筋膜炎或脓肿。诊断很大程度上仍依赖临床判断，皮肤科医生和/或传染病专家的评估仍是临床金标准。因此，获得专科护理以及对热成像等有用辅助措施进行进一步研究，对于准确诊断和管理以防止不恰当使用抗生素至关重要。自社区获得性耐甲氧西林金黄色葡萄球菌首次出现以来，多重耐药性一直在演变，最近的研究表明，社区中耐甲氧西林金黄色葡萄球菌的总体发病率有所下降，美国南部地区的发病率仍然最高。尽管耐药模式不断变化，但不恰当的处方模式依然存在，并导致对甲氧苄啶-磺胺甲恶唑和克林霉素等抗生素的耐药率上升。因此，无论是对于个体患者的治疗效果还是公共卫生而言，采用尽可能窄谱的抗菌治疗进行准确诊断和后续管理都是理想的。
