Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The ALT-70 score for cellulitis is a tool designed to assess the likelihood of cellulitis in patients by considering four key clinical factors. Each factor is rated with a specific point value, and the total score informs the probability of cellulitis.

You input four true or false answers related to these clinical factors:
- Presence of asymmetric skin abnormalities
- Age of 70 years or older
- White blood cell count of 10,000/mcL or more
- Heart rate of 90 beats per minute or more

The scoring for these factors is as follows:
- Asymmetric skin abnormalities contribute 3 points
- Age of 70 years or older adds 2 points
- White blood cell count of 10,000/mcL or more adds 1 point
- Heart rate of 90 beats per minute or more also adds 1 point

To compute the ALT-70 score, you sum the points of all true responses, resulting in a total score ranging from 0 to 7.

Interpreting the score:
- A score of 0 to 2 suggests a low probability of cellulitis. It’s advisable to explore other diagnoses.
- A score between 3 and 4 indicates an intermediate probability and suggests consulting a specialist for further evaluation.
- A score from 5 to 7 implies a high probability of cellulitis, for which initiating treatment may be recommended.

The ALT-70 is a clinical prediction rule for cellulitis. It is used to differentiate cellulitis from pseudocellulitis in adult patients presenting with lower extremity redness. The acronym ALT-70 stands for Age (over 70), Lesion characteristics (asymmetry, well-demarcated border), Temperature (37.9°C or higher), and White blood cell count (more than 10,000 cells/mm³). Each of these four factors is assigned a score, and the total score is used to predict the likelihood of true cellulitis. This calculator is particularly useful in emergency departments and outpatient settings to guide treatment decisions and avoid unnecessary antibiotic use. It should not be used in patients with known skin infections other than cellulitis, or in patients with skin changes due to chronic conditions like venous insufficiency or lymphedema.

ALT-70 score for cellulitis

The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a tool used to evaluate the likelihood of necrotizing fasciitis, a serious bacterial skin infection. This tool considers six laboratory parameters: C-reactive protein (CRP), white blood cell count (WBC), hemoglobin, sodium, creatinine, and glucose. Each of these factors contributes to the LRINEC score based on its value.

- C-reactive protein:
  - Less than 15 mg/dL (150 mg/L) scores 0
  - 15 mg/dL (150 mg/L) or greater scores 4

- White blood cell count:
  - Less than 15,000/mcL scores 0
  - Between 15,000 and 25,000/mcL scores 1
  - Greater than 25,000/mcL scores 2

- Hemoglobin:
  - Greater than 13.5 g/dL scores 0
  - Between 11 and 13.5 g/dL scores 1
  - Less than 11 scores 2

- Sodium:
  - 135 mmol/L or greater scores 0
  - Less than 135 mmol/L scores 2

- Creatinine:
  - 1.6 mg/dL (141 mcmol/L) or less scores 0
  - Greater than 1.6 mg/dL (141 mcmol/L) scores 2

- Glucose:
  - 180 mg/dL (10 mmol/L) or less scores 0
  - Greater than 180 mg/dL (10 mmol/L) scores 1

To find the final LRINEC score, each parameter is assigned a score according to the values listed. All individual scores are summed, resulting in a total score that falls between 0 and 13. This total score helps evaluate the risk of necrotizing fasciitis:

- Scores from 0 to 5 indicate a low risk.
- Scores of 6 or 7 suggest an intermediate risk.
- Scores 8 or above signify a high risk.

Interpreting the LRINEC score enables healthcare professionals to assess the potential risk of necrotizing fasciitis, providing insight that may guide further diagnostic procedures or treatment decisions.

The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a clinical calculator used to assess the risk of necrotizing fasciitis, a severe type of soft tissue infection, in patients presenting with severe skin and soft tissue infections. The LRINEC score is calculated based on six laboratory values: C-reactive protein (CRP), white blood cell count (WBC), hemoglobin, sodium, creatinine, and glucose levels. 

This calculator is applicable to patients with severe skin and soft tissue infections where there is a suspicion of necrotizing fasciitis. The clinical utility of the LRINEC score is to aid in the early identification of necrotizing fasciitis, which is critical as this condition can rapidly progress and become life-threatening. 

The LRINEC score may not be applicable or accurate in patients with underlying conditions that can affect the laboratory values used in the score, such as chronic kidney disease (which can affect creatinine levels) or diabetes (which can affect glucose levels). It should also be noted that a low LRINEC score does not completely rule out necrotizing fasciitis, and clinical judgment should always be used in conjunction with this scoring system.

Laboratory Risk Indicator for Necrotizing Fasciitis score (LRINEC score)

Cellulitis

Antibiotic therapy

Antibiotic therapy, MRSA coverage

Management of recurrent cellulitis

Management of recurrent cellulitis (decolonization strategies)

Antibiotic therapy, initial empiric therapy

As per KDA/KOA/KSC/KSID 2017 guidelines, 

Management of recurrent cellulitis, predisposing conditions

Management of recurrent cellulitis (hygiene practices)

Blood and skin cultures

Setting of care

Pediatric patients

Immunocompromised patients

Immunocompromised patients (management)

Patients with febrile neutropenia

Patients with febrile neutropenia (evaluation)

Methicillin-resistant Staphylococcus aureus polymerase chain reaction

MRSA PCR

Patients with febrile neutropenia (management)

Patients with Vibrio vulnificus infection

Adjunctive corticosteroids

Elevation of the affected area

Clinical assessment

Management of underlying conditions

Immunocompromised patients (evaluation)

Repeat microbiological testing

Management of recurrent cellulitis, prophylactic antibiotics

Antibiotic therapy, duration

Incision and drainage

Patients with febrile neutropenia (persistent/recurrent episodes)

Patients with cellular immunodeficiency

Diagnostic imaging

Updated 2024 ESCMID guidelines for laboratory testing and antimicrobial stewardship in cellulitis and erysipelas in the emergency department


Cellulitis

Background

Overview

Guidelines

Key sources