Skin and Soft Tissue Infections
Key Points
Key Points
- There was a 29% increase in the total hospital admissions for these infections between 2000 and 2004.
- 6.3 million physician’s office visits per year are attributable to SSTIs.
- Between 1993 and 2005, annual emergency department visits for SSTIs increased from 1.2 million to 3.4 million patients.
- Some of this increased frequency is related to the emergence of community associated methicillin-resistant S. aureus (MRSA).
When developing an adequate differential diagnosis and an appropriate index of suspicion for specific etiological agents it is essential to obtain a careful history that includes information about the patient’s immune status, geographical locale, travel history, recent trauma or surgery, previous antimicrobial therapy, lifestyle, hobbies, and animal exposure or bites.
Recognition of the physical examination findings and understanding the anatomical relationships of skin and soft tissue are crucial for establishing the correct diagnosis.
When information from history and physical are insufficient, biopsy or aspiration of tissue may be necessary, and radiographic procedures may be critical to determine the level of infection and the presence of gas, abscess or a necrotizing process.
Surgical exploration or debridement is an important diagnostic as well as therapeutic procedure in patients with necrotizing infections or myonecrosis.
Treatment
Treatm...
...mpetigo and Ec...
...m stain and culture of the pus or exudat...
...tment without these studies is reasonable in ty...
...tment of bullous and nonbullous impetigo...
...apy for ecthyma or impetigo should be a 7-day reg...
...e S. aureus isolates from impetigo and...
...microbials should be used for infections...
...anagement of SSTI Infections...
...s (cutaneous abscesses, furuncles, carbu...
...and culture of pus from carbuncles and abscesse...
...stain and culture of pus from inflame...
...ion and drainage is the recommended treatmen...
...to administer antibiotics directed ag...
...n antibiotic active against MRSA is re...
Recurrent Skin Absce...
...recurrent abscess at a site of prev...
...scesses should be drained and cultured early in...
...g cultures of recurrent abscess, t...
...5-day decolonization regimen of intr...
...patients should be evaluated for...
...pelas and Cellulitis
...od or cutaneous aspirates, biopsies, or swabs a...
...res of blood are recommended, (SR, M)21881...
...ltures and microscopic examination of cut...
...cases of cellulitis without systemic signs of infe...
...or cellulitis with systemic signs of i...
...atients whose cellulitis is associated...
...mpromised patients as defined above (Se...
...lus either piperacillin-tazobactam or...
...nded duration of antimicrobial therapy is 5 days,...
...ation of the affected area and treatment...
...extremity cellulitis, clinicians shou...
...rapy is recommended for patients who do not...
...n is recommended if there is concern for a...
...inflammatory Agents for Cellulitis...
...c corticosteroids (eg, prednisone 40 mg da...
Recurrent Cellulit...
...ntify and treat predisposing conditions s...
...ctices should be performed as part of routine...
...stration of prophylactic antibiotic...
...should be continued so long as the predispos...
...ure 2. Wound Infection Al...
...rgical Site Infecti...
...uture removal plus incision and draina...
...emic antimicrobial therapy is NOT routinely indica...
...rse of systemic antimicrobial therapy...
...first-generation cephalosporin or an ant...
...active against Gram-negative bacteria and anaer...
...ng Fasciitis, Including Fournier's Gangrene...
...mpt surgical consultation is recommended for patie...
...iric antibiotic treatment should be bro...
...llin plus clindamycin is recommended...
...yomyosit...
...resonance imaging (MRI) is the recommended imag...
...f blood and abscess material should be obtained...
...omycin is recommended for initial em...
...n or antistaphylococcal penicillin (eg, na...
...arly drainage of purulent material...
...tudies should be performed in patients with persis...
...tics should be administered intravenously initia...
...l Gas Gangrene or Myonecrosis...
...t surgical exploration of the suspecte...
...sence of a definitive etiologic diagnosis,...
...antimicrobial therapy with penicillin and...
...gen (HBO) therapy is NOT recommended because it h...
...reemptive Antimicrobial Therapy to Preve...
...eemptive early antimicrobial therapy for 3...
...sure prophylaxis for rabies may be indicated....
Infected Animal Bite Wounds
...imicrobial agent or agents active against both...
...etanus toxoid should be administered...
...Wound Closure for Animal Bite Wounds...
...ary wound closure is NOT recommended...
...s may be approximated. (WR, L)2188...
...neous Anthrax...
...in V 500 mg qid for 7-10 days is the recommended...
...profloxacin 500 mg PO bid or levofloxacin 500 mg...
...h Disease and Bacillary Angiomatosis...
...thromycin is recommended for cat sc...
...ients >45 kg, 500 mg on day 1 followed...
...atient...
...ythromycin 500 mg qid or doxycycline 100 mg bid...
...rysipeloid
...00 mg qid or amoxicillin 500 mg tid...
...lander...
...tazidime, gentamicin, imipenem, doxycycline or ci...
...onic Plagu...
...e should be diagnosed by Gram stain and...
...5 mg/kg IM q12h or doxycycline 100...
...ntamicin could be substituted for strept...
...laremia...
...ic tests are the preferred method of...
...15 mg/kg q12h IM or gentamicin 1.5 mg/kg q8...
...ycline 500 mg qid or doxycycline 100 mg bid PO is...
...the microbiology laboratory if tula...
...mmunocompromised P...
...ion to infection, differential diagnosis...
...ial diagnosis for infection of skin lesions sho...
...ration of the lesion to obtain material f...
...ever and Neutropenia
...ine whether the current presentation of fev...
...ressively determine the etiology of...
...patients with fever and neutropenia accord...
...ith a MASCC of ≥21 (SR, M)218...
...e the extent of infection through a thoroug...
...tial Antibiotic Thera...
...on and empiric antibacterial therapy with...
...d clinical and microbiologic SSTIs should be...
...ment duration for most bacterial SSTIs shou...
...rvention is recommended for drainage of so...
...y-stimulating factor therapy (G-CSF,...
...cyclovir should be administered to...
...t or Recurrent Episodes...
...remain the primary cause of infection-associa...
...ministration of vancomycin or other agents with...
...ida spp. SSTIs should be treated w...
...nazole as an acceptable alternative. (S...
...eatment should be for 2 weeks after clearance of b...
...rgillus SSTIs should be treated with voriconazol...
...atively, lipid formulations of amphotericin B,...
...hizopus infections should be treate...
...nazole (Table 5). (SR, L)21881...
...an echinocandin could be considered...
...um spp. infections should be treated...
...nt for antibiotic-resistant bacterial...
...ravenous acyclovir should be added to the patient...
...d cultures should be obtained, and skin le...
...ty of a single serum fungal antigen test (1...
...olymerase chain reaction (PCR) in peripheral bloo...
...ar Immunodeficiency...
...der immediate consultation with a dermatologist...
...nsider biopsy and surgical debridement earl...
...c antibiotics, antifungals and/or ant...
...fic agents should be decided with...
...ntimicrobial therapy for Staphylococc...
...ble 2. Treatment of Necrotizing Infections...
...tics for Treatment of Incisional Sur...
...able 4. Recommended Therapy for Infections af...
...ard Doses of Antifungal AgentsHaving trouble...
...6. Standard Doses of Antimicrobial Agents Activ...