Page 1 of 1

Cellulitis and Abscess Management in the Era of Resistance to Antibiotics (CAMERA)

Cellulitis and Abscess Management in the Era of Resistance to Antibiot

Appendix A. Skin and Soft Tissue Infection Action Plan

Date: ___________________

Allergies:

Notes:

Fever:

History of Fever: Y   N
Temperature at Visit: ________ ° 1 C  ___ 2 F ___

Vital Signs:

Pulse –
Blood Pressure –

Risk for MRSA:

__ Recent hospitalization (within 1 month)__ Other skin condition__________________
__ Family Member with MRSA (in last 6 months)__ Immunocompromized:________________
__ Sport team: ______________________________Diabetes
__ History of MRSA: ____________________Other risk factor:_____________________
__Excema__None of the above

Number of Infected Lesions: ________

 Site 1Site 2Site 3Site 4
General description of infection
Duration (days)    
Location (face, neck, trunk, arm, hand, buttock, leg, foot, elsewhere)    
Size (cm, greatest diameter)    
Red (erythema)Y       NY       NY       NY       N
Swollen (edema)Y       NY       NY       NY       N
WarmY       NY       NY       NY       N
Painful/TenderY       NY       NY       NY       N
Other Findings    
Is it an abscess?
FluctuantY       NY       NY       NY       N
Yellow or White CenterY       NY       NY       NY       N
Central Point or “Head”Y       NY       NY       NY       N
Draining pus (discharge, purulent)Y       NY       NY       NY       N
Other Findings    
Was it Drained?
I&DY       NY       NY       NY       N
Needle AspirationY       NY       NY       NY       N
Manually ExpressedY       NY       NY       NY       N
PackedY       NY       NY       NY       N
Referred for Further Management to: 
Was a Culture and Sensitivity Analysis Obtained?
 Y       NY       NY       NY       N

Summary of other sites if more than four:

Antibiotic:

___ None
___ Empiric Treatment for suspected MRSA
    (e.g., clindamycin, doxycycline, minocycline, trimethoprin-sulfamethoxazole)

    Rx: ____________________________________

___ Empiric Treatment for non-MRSA or Streptococcus (e.g., beta lactam)

    Rx: ____________________________________

___ Other Rx: ____________________________________

Patient Followup:

___ PRN
___ Scheduled for _______ days

Patient Education:

___ CDC Information Sheet
___ Other: __________________________

CPT Codes:
10060 – Simple or single I&D or needle aspiration
10061 – Complicated or multiple I&D or needle aspiration


ICD-9 Codes:
041.1 Staphylococcus infection
680.X* Carbuncle or furuncle
681.00 Cellulitis or abscess of finger
681.10 Cellulitis or abscess of the toe
681.9 Cellulitis or abscess of unspecified digit
682.X* Other cellulites or abscess
* X=.0 face, .1 neck, .2 trunk, .3 arm, .4 hand, .5 buttock, .6 leg, .7 foot, .8, head, .9 elsewhere


Follow-up:

___ Final Culture Result: ____________________________________ Date: _______________
___ Patient Notified:  Y   N   ; Date: __________________
___ New Rx: __________________________
___ Other: __________________________

Return to Contents
Proceed to Next Section

Current as of March 2011
Internet Citation: Cellulitis and Abscess Management in the Era of Resistance to Antibiotics (CAMERA): Cellulitis and Abscess Management in the Era of Resistance to Antibiot. March 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/mrsa/nc_mrsaapa.html