We have defined cellulitis in burn patients as a new area of redness and induration extending beyond the limits of the initial wound with or without pain, leukocytosis or fever. Our goal is to determine our incidence of cellulitis, identify those at high risk and identify ways to reduce this complication. For quality improvement measure, we reviewed charts of patients admitted to our regional burn center from January 2010 to June 2011. Using burn center patient cards, demographic data were collected as was burn size and location, time from injury to onset of cellulitis, time of injury to excision and antibiotics used for treatment. None of our patients received prophylactic antibiotics after thermal injury. During an 18 month period, we saw 722 new thermal injury burn patients; 273 were admitted to the hospital, 210 fit inclusion criteria. Fifteen (7.1%) patients admitted had existing cellulitis. An additional 36 (17.1%) patients developed cellulitis. We admitted 88 facial burns, 181 burns of the upper extremity/hands, 74 of the anterior trunk, 48 of the back/flank and 103 of the lower extremity/feet. Patients with lower extremity burns were three times as likely to develop cellulitis compared to those burned in other locations (OR=3.282, 95% CI 1.536-6.975, p<0.001). These data suggest an unexpectedly high incidence of cellulitis in lower extremity burns. As a result of this QI, we have reached a consensus on how we define and treat burn wound cellulitis at our institution. The use of prophylactic antibiotics for lower extremity burns warrants a prospective randomized study.