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
...eatment
...petigo and Ecthyma...
...stain and culture of the pus or exudates...
...eatment without these studies is reasonable in t...
...eatment of bullous and nonbullous i...
...erapy for ecthyma or impetigo should be a 7-d...
...us isolates from impetigo and ecthyma are...
...ic antimicrobials should be used for infe...
...re 1. Management of SSTI Infections...
...ent SSTIs (cutaneous abscesses, furuncle...
...ulture of pus from carbuncles and abscesses ar...
...am stain and culture of pus from infl...
Incision and drainage is the recommended...
...he decision to administer antibiotics...
...ibiotic active against MRSA is recommended for...
...ecurrent Skin Abscesse...
...rrent abscess at a site of previous infec...
...rent abscesses should be drained and...
...obtaining cultures of recurrent absc...
...er a 5-day decolonization regimen of intran...
...patients should be evaluated for neutrophil...
...sipelas and Cellulitis
...tures of blood or cutaneous aspirat...
...res of blood are recommended, (SR, M)21881...
...ultures and microscopic examination...
...es of cellulitis without systemic s...
...is with systemic signs of infection...
...patients whose cellulitis is associate...
...severely compromised patients as defined above...
...either piperacillin-tazobactam or imipenem/...
...mmended duration of antimicrobial therapy is 5...
...tion of the affected area and treatment of predisp...
...ower extremity cellulitis, clinicians should c...
...herapy is recommended for patients who do not ha...
...spitalization is recommended if there is con...
...tory Agents for Cellulitis...
...emic corticosteroids (eg, prednisone 40 mg daily...
...ecurrent Cellulit...
...treat predisposing conditions such as e...
...ices should be performed as part of routine patien...
...f prophylactic antibiotics, such as o...
...should be continued so long as the...
...2. Wound Infection Algor...
...al Site Infections...
...removal plus incision and drainage should be per...
...systemic antimicrobial therapy is NOT routi...
...se of systemic antimicrobial therapy...
...on cephalosporin or an anti-staphylococ...
...gents active against Gram-negative bacteri...
...izing Fasciitis, Including Fournier...
...consultation is recommended for patie...
...antibiotic treatment should be broad...
...plus clindamycin is recommended fo...
...myositis...
...ic resonance imaging (MRI) is the recom...
...lood and abscess material should be...
...cin is recommended for initial empiric...
...or antistaphylococcal penicillin (eg, nafcill...
...f purulent material should be performed. (SR, H...
...peat imaging studies should be performed i...
...ould be administered intravenously ini...
...lostridial Gas Gangrene or...
...al exploration of the suspected gas gangre...
...the absence of a definitive etiolo...
...microbial therapy with penicillin and cli...
...en (HBO) therapy is NOT recommended because i...
...imicrobial Therapy to Prevent Infect...
...ptive early antimicrobial therapy for 3-5 days is...
...prophylaxis for rabies may be indicated. Consulta...
...Animal Bite Wounds...
...imicrobial agent or agents active against...
...toxoid should be administered to pat...
...ary Wound Closure for Animal Bite Wo...
...rimary wound closure is NOT recommended for w...
...unds may be approximated. (WR, L)21881...
...aneous Anthrax...
...llin V 500 mg qid for 7-10 days is the...
...acin 500 mg PO bid or levofloxacin...
...atch Disease and Bacillary Angiomatosis...
...mycin is recommended for cat scratch disease (S...
...ients >45 kg, 500 mg on day 1 followed by 250...
...tients...
...0 mg qid or doxycycline 100 mg bid f...
...ysipeloid...
...n 500 mg qid or amoxicillin 500 mg tid for 7-1...
...anders...
...idime, gentamicin, imipenem, doxycycline or...
...ubonic Pla...
Bubonic plague should be diagnosed by Gram stain...
...15 mg/kg IM q12h or doxycycline 100...
...cin could be substituted for streptomyci...
...laremia...
...gic tests are the preferred method...
...n 15 mg/kg q12h IM or gentamicin 1....
...e 500 mg qid or doxycycline 100 mg b...
...the microbiology laboratory if tularemia...
...unocompromised Patients...
...nfection, differential diagnosis of skin les...
Differential diagnosis for infection of...
...iopsy or aspiration of the lesion to obtain mat...
...er and Neutropenia...
...e whether the current presentation of fever a...
...determine the etiology of the SSTI by...
...ify patients with fever and neutropenia acco...
...h a MASCC of ≥21 (SR, M)21881...
...extent of infection through a thoro...
...Antibiotic Therapy...
...ation and empiric antibacterial therapy w...
...ed clinical and microbiologic SSTI...
...ent duration for most bacterial SSTIs shou...
...al intervention is recommended for drainage of...
...olony-stimulating factor therapy (G-CSF, GM...
Acyclovir should be administered to pati...
...stent or Recurrent Episod...
...and molds remain the primary cause o...
...iric administration of vancomycin or...
...SSTIs should be treated with an echinocandin or...
...nazole as an acceptable alternative....
...reatment should be for 2 weeks after clearance...
...llus SSTIs should be treated with voric...
...alternatively, lipid formulations of amphotericin...
...opus infections should be treated with lipi...
...conazole (Table 5). (SR, L)218...
...an echinocandin could be considered base...
...spp. infections should be treated wit...
...ment for antibiotic-resistant bacterial organis...
...clovir should be added to the patient’s a...
...es should be obtained, and skin lesions...
...sensitivity of a single serum fungal...
...erase chain reaction (PCR) in peripher...
...lar Immunodeficiency...
...diate consultation with a dermatologi...
...iopsy and surgical debridement early...
Empiric antibiotics, antifungals and...
...use of specific agents should be decid...
...ble 1. Antimicrobial therapy for Staphylococc...
...able 2. Treatment of Necrotizing Infections of th...
...iotics for Treatment of Incisional Surgical...
...4. Recommended Therapy for Infections after Anima...
...tandard Doses of Antifungal AgentsHaving troub...
...e 6. Standard Doses of Antimicrobial Agents A...