(CS-007) Source Control of Bacteria in Wound Associated Cellulitis Prevents Progressive Cellulitis with its Associated Complications and the Overuse of Antibiotics

We have observed cases of cellulitis that were not responding to antibiotics because the source of the bacteria was not identified and treated (Source Control).  The source is usually a wound or ulcer that has bacteria that have not been identified and treated with guided debridement and local wound care.  We address antibiotic-resistant cellulitis by identifying and treating the source through bedside bacterial fluorescence imaging*. This diagnostic tool identifies the presence and location of bacteria at the wound site. Removing the bacteria through fluorescence*-guided debridement eliminates the root cause, enabling systemic antibiotics to work, and preventing multiple courses and antibiotic resistance.

Methods: A 2-patient case series depicting the management of recurrent or refractory cellulitis through targeted treatment of the bacterial source of the cellulitis. Fluorescence imaging* was used to objectively identify and assess the source of the bacteria at the wound or ulcer site. This technology signals the presence and location of bacteria at loads of 10⁴ CFU/g or higher.  Once the bacteria are identified in the wound it is treated by fluorescence*-guided debridement and local wound care.

Results: Fluorescence imaging* correctly identified and targeted bacterial sources in cases of refractory cellulitis cases allowing for the systemic treatment to act. This approach, validated microbiologically, contrasts with prior ineffective antibiotic courses lacking bacterial source management. Effective cellulitis control ensued only after addressing the identified bacterial source.

Discussion:

Our experience and previously published evidence have identified a significant association between untreated wounds and the onset of cellulitis, emphasizing the importance of prompt wound care in preventing such complications. Additionally, the use of antibiotics without controlling the root cause of the infection is linked to adverse effects, including increased healthcare costs and heightened risks of antibiotic resistance. Treating systemic infections without eliminating bacteria at the source is ineffective, fostering antibiotic overuse and fueling resistance. Our study underscores the vital importance of an enhanced, objective, and targeted approach to cellulitis, prioritizing the infected wound as the root cause rather than just addressing the consequence (cellulitis).