Cellulitis: Insights on Treatment and Antibiotic Resistance

Cellulitis

Dear Dr.
Wu,
Thanks to your care, I am still doing well.
Previously, I underwent radiation treatment for skin metastasis, and the situation has improved significantly.
However, I recently experienced lymphatic rupture, which led to cellulitis (without any open wounds).
Initially, there was redness, swelling, and elevated white blood cell count.
After a week of treatment, the condition improved considerably, reducing from a large area to a small patch.
Although it did not worsen, it also did not improve further.
After about two weeks, my doctor noted that the inflammatory markers had decreased and discharged me, prescribing a week’s worth of antibiotics to take at home.
However, after a week, there was still no improvement, so I consulted an infectious disease specialist.
The specialist requested a surgical intervention to clean the area, followed by about five days of Augmentin, which was ineffective.
The bacterial culture revealed resistant bacteria, so the treatment was switched to Vancomycin for two days, but due to difficulty accessing veins, it was changed to Teicoplanin administered intramuscularly.
I have been on this for several days now, but there has been no improvement.
When I asked my attending physician, he stated that as long as the surgical area is cleaned properly, systemic antibiotics are unnecessary, as their efficacy may not reach the affected area, and he expressed concern about developing antibiotic resistance.
He advised me to be discharged.
However, the infectious disease doctor mentioned that if this issue is not resolved, there could be future complications, urging me to trust his judgment.
I would like to ask:
1.
What is your opinion, Dr.
Wu?
2.
If antibiotics are continuously changed, will this lead to the development of resistance, making it difficult to treat even minor inflammations in the future?
3.
Is it possible to leave this condition untreated and allow the body to heal itself?
Thank you for taking the time to answer my questions.
I appreciate it.

len, 40~49 year old female. Ask Date: 2009/08/23

Dr. Wu Jingtang reply Breast and Thyroid

Dear Miss Len,
I am glad to hear about your current condition.
You and your medical team deserve a heartfelt encouragement! Patients who have undergone surgery and radiation therapy may experience cellulitis due to circulatory disruption.
I see that your treatment has been well managed.
If you can also enhance your immune system (through adequate rest, a balanced diet, massage, rehabilitation, and traditional Chinese medicine), it should be beneficial! The increasing use of antibiotics raises concerns about antibiotic resistance, which could complicate future treatments.
Currently, the lesion has not expanded, and the use of intramuscular injections for medication should not be considered "neglect." You can try the aforementioned methods to support your body's self-healing.
Keep pushing forward; you are truly resilient! Wishing you peace and health.
Sincerely,
Dr.
Wu Ching-Tang
Attending Surgeon, Department of Surgery
Taoyuan General Hospital, Ministry of Health and Welfare
980824

Reply Date: 2009/08/23

More Info

Dear Patient,
Thank you for sharing your experience with cellulitis and the challenges you've faced with antibiotic resistance. Your situation highlights a significant concern in modern medicine: the management of infections in the context of antibiotic resistance. Let’s address your questions and provide some insights into the treatment of cellulitis and the implications of antibiotic use.

1. Understanding Antibiotic Resistance: Antibiotic resistance occurs when bacteria evolve and develop the ability to defeat the drugs designed to kill them. This can happen through various mechanisms, such as genetic mutations or acquiring resistance genes from other bacteria. In your case, the identification of antibiotic-resistant bacteria in your culture indicates that the bacteria causing your cellulitis have developed resistance to the antibiotics that were previously effective. This is a growing concern in healthcare, as it limits treatment options and can lead to prolonged infections or complications.

2. Antibiotic Use and Resistance Development: It is a common misconception that using antibiotics will always lead to the development of resistance. While it is true that inappropriate or excessive use of antibiotics can contribute to resistance, the relationship is complex. Not every course of antibiotics will result in resistance, especially if the treatment is appropriate and targeted. However, the more frequently antibiotics are used, especially broad-spectrum ones, the higher the risk of resistance developing. This is why healthcare providers often recommend using the narrowest spectrum antibiotic that is effective for the specific infection.

3. The Role of Surgery in Treatment: In cases of cellulitis, especially when there is an abscess or significant tissue involvement, surgical intervention may be necessary to drain the infected area. This can help remove the source of infection and allow antibiotics to work more effectively. Your surgeon's recommendation to clean the area surgically is a standard practice, especially when antibiotics alone are insufficient. It is essential to follow up with your healthcare provider to monitor your recovery and ensure that the infection does not recur.

4. Self-Healing vs. Medical Intervention: While the body has a remarkable ability to heal itself, certain infections, particularly those caused by resistant bacteria, may not resolve without medical intervention. Allowing an infection like cellulitis to go untreated can lead to severe complications, including systemic infection (sepsis), which can be life-threatening. Therefore, it is crucial to follow your healthcare provider's advice and not to ignore persistent symptoms.

5. Future Considerations: If you are concerned about the potential for future infections and the effectiveness of antibiotics, it is important to maintain open communication with your healthcare team. They can help monitor your health and adjust treatment plans as necessary. Additionally, lifestyle factors such as maintaining a healthy diet, managing stress, and practicing good hygiene can help support your immune system.

In conclusion, while antibiotic resistance is a serious issue, it is manageable with careful monitoring and appropriate treatment strategies. Your healthcare providers are best positioned to guide you through this process, ensuring that you receive the most effective care while minimizing the risk of resistance. If you have further concerns or questions, do not hesitate to reach out to your healthcare team for personalized advice.

Wishing you a speedy recovery and good health.

Best regards.

Similar Q&A

Understanding Cellulitis: Common Areas of Infection and Treatment

Cellulitis commonly occurs in areas of the body where the skin is broken or compromised, such as the legs, arms, and face. It can also affect other regions, particularly where there are underlying conditions that predispose the skin to infection.

Dr. Xie Wenhuai reply Surgery
Definition of cellulitis: The subcutaneous fat layer of the human body has a honeycomb-like structure, so when inflammation occurs in this area, it is referred to as "cellulitis." Causes: Bacterial infection is the primary cause. If there is a wound on the skin, bacteri...

Effective Post-Treatment Strategies for Wounds After Cellulitis

If you have a wound left from cellulitis, how should it be treated?

Dr. Xie Wenhuai reply Surgery
Cellulitis is usually caused by wound infections (redness, swelling, heat, and pain). After treatment, which includes incision and drainage as well as antibiotics, the redness and swelling subside, and the wound heals. Sometimes, it may recur; if it recurs frequently, considerati...

Understanding Cellulitis: Recovery Challenges and Treatment Options

Hello Doctor, my mother was hospitalized for cellulitis at the end of April this year. She had no visible wounds, but her foot became red, swollen, and painful for no apparent reason. Bacteria were cultured during her hospitalization, which lasted over three weeks. During her sta...

Dr. Liao Zhongxin reply Internal Medicine
Dear readers: 1. If bacteria are cultured from a case of cellulitis, appropriate treatment can be based on the culture report; as long as the medication is correct and administered for a sufficient duration, there should be no subsequent issues. 2. When caring for wounds, it ...

Managing Cellulitis: A 11-Day Hospital Journey and Ongoing Challenges

On October 11, the patient experienced foot pain and sought medical attention at a general orthopedic clinic. The doctor prescribed anti-inflammatory and pain relief medication for three days. By October 14, there was no improvement, and the knee was swollen, making it impossible...

Dr. Liao Zhongxin reply Internal Medicine
Dear readers, 1. I have a general understanding of your (or your family member's) condition; it may be necrotizing fasciitis or severe soft tissue inflammation. This is inherently a serious and challenging condition to manage. 2. First, it is important to assess whether...