The growth of managed care in the U.S. was spurred by the enactment of the Health Maintenance Organization Act of 1973. While managed care techniques were pioneered by health maintenance organizations, they are now used by a variety of private health benefit programs.
1 Cellulitis is a spreading bacterial infection of the skin and tissues beneath the skin. 2  Staphylococcus and Streptococcus are the types of bacteria that are usually responsible for cellulitis, although many types of bacteria can cause the condition. Sometimes cellulitis appears in areas where the skin has broken open, such as the skin near ulcers or surgical wounds. 2  Symptoms and signs include redness, tenderness, swelling, and warmth of the affected area. 3  Cellulitis is not contagious.
S. pyogenes: major cause of cellulitis, but very hard to culture in this setting. Always sensitive to penicillin, which is drug of choice. Most common form of cellulitis: leg (tibial area) with breach in skin usually due to intertrigo. Treatment: always cover Streptococci which is always sensitive to beta-lactams.