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
...reatmen...
...etigo and Ecth...
...n and culture of the pus or exudates from s...
...without these studies is reasonable...
...ent of bullous and nonbullous impetigo should...
Oral therapy for ecthyma or impetigo should...
...s isolates from impetigo and ecthyma are usu...
...robials should be used for infecti...
...igure 1. Management of SSTI Infection...
...ulent SSTIs (cutaneous abscesses, furuncles, carb...
...tain and culture of pus from carbuncles...
...m stain and culture of pus from inflamed ep...
...drainage is the recommended treatment for inf...
...administer antibiotics directed against...
...otic active against MRSA is recommended for...
...rrent Skin Abscesses...
...abscess at a site of previous infection s...
...abscesses should be drained and cultured...
...aining cultures of recurrent abscess,...
...a 5-day decolonization regimen of intrana...
...patients should be evaluated for neutrophil diso...
...as and Cellulitis...
...f blood or cutaneous aspirates, biop...
...res of blood are recommended, (SR, M)2...
...and microscopic examination of cutaneo...
...cases of cellulitis without systemic signs of...
...ith systemic signs of infection (See Fig. 1/Non...
...atients whose cellulitis is associated with pene...
...ompromised patients as defined above (See...
...either piperacillin-tazobactam or imipenem/mero...
...duration of antimicrobial therapy is 5 days, but...
...of the affected area and treatment of...
...ower extremity cellulitis, clinicians should c...
...rapy is recommended for patients who do...
...ion is recommended if there is concer...
...flammatory Agents for Cell...
...ic corticosteroids (eg, prednisone 40 mg daily...
...rrent Celluliti...
...ntify and treat predisposing conditio...
...ractices should be performed as par...
...nistration of prophylactic antibiotics, such as o...
...hould be continued so long as the p...
...Wound Infection Algorithm
...cal Site Infectio...
...oval plus incision and drainage shou...
...ve systemic antimicrobial therapy i...
A brief course of systemic antimicrobial therapy i...
...ration cephalosporin or an anti-staphylococcal...
...ctive against Gram-negative bacteria and...
...izing Fasciitis, Including Fournier's...
...cal consultation is recommended for patients with...
...tic treatment should be broad (eg, vanco...
...clindamycin is recommended for treatme...
...yomyosit...
...tic resonance imaging (MRI) is the re...
...lood and abscess material should be o...
...in is recommended for initial empiric therapy. A...
...r antistaphylococcal penicillin (eg, nafcillin or...
...drainage of purulent material should be...
Repeat imaging studies should be performe...
...ibiotics should be administered intravenously init...
...Gas Gangrene or Myonecrosis...
...surgical exploration of the suspected gas...
...e of a definitive etiologic diagnosi...
...e antimicrobial therapy with penicillin and clin...
...perbaric oxygen (HBO) therapy is NO...
...icrobial Therapy to Prevent Infection for Dog...
...e early antimicrobial therapy for 3...
...exposure prophylaxis for rabies may be indicat...
...cted Animal Bite W...
...n antimicrobial agent or agents activ...
...d should be administered to patients...
...rimary Wound Closure for Animal B...
Primary wound closure is NOT recommended for...
...may be approximated. (WR, L)21...
...eous Anthrax...
...V 500 mg qid for 7-10 days is the recommended t...
...ofloxacin 500 mg PO bid or levofloxacin...
...sease and Bacillary Angiomatosis...
...recommended for cat scratch disease (SR, M)acc...
Patients >45 kg, 500 mg on day 1 follo...
...ients...
...in 500 mg qid or doxycycline 100 mg bid for 2...
...rysipelo...
...cillin 500 mg qid or amoxicillin 500 mg tid...
...anders
...gentamicin, imipenem, doxycycline or ciprofloxac...
...ubonic Plague...
...plague should be diagnosed by Gram st...
...treptomycin 15 mg/kg IM q12h or doxycy...
...uld be substituted for streptomycin....
...ularemia
...tests are the preferred method of diagnosi...
...n 15 mg/kg q12h IM or gentamicin 1.5 mg/kg...
...e 500 mg qid or doxycycline 100 mg bid PO...
...ify the microbiology laboratory if tularemia...
...mmunocompromised Pa...
...to infection, differential diagnosis of...
...tial diagnosis for infection of skin les...
...aspiration of the lesion to obtain material for...
...and Neutropenia...
...ether the current presentation of fever and neutro...
...gressively determine the etiology of the SSTI by a...
...isk-stratify patients with fever and...
...ith a MASCC of ≥21 (SR, M...
...etermine the extent of infection through a thor...
...tial Antibiotic Th...
...ospitalization and empiric antibacterial...
...ed clinical and microbiologic SSTIs should...
...he treatment duration for most bacterial SSTIs...
...l intervention is recommended for draina...
...ny-stimulating factor therapy (G-CS...
Acyclovir should be administered to patients sus...
...nt or Recurrent Episodes...
...olds remain the primary cause of infe...
...nistration of vancomycin or other agents wi...
...Is should be treated with an echinoca...
...ole as an acceptable alternative. (SR, M)21...
...ment should be for 2 weeks after clearance of...
...gillus SSTIs should be treated with...
...alternatively, lipid formulations of amphote...
...r/Rhizopus infections should be treated with...
...azole (Table 5). (SR, L)21881
...ition of an echinocandin could be considered bas...
...arium spp. infections should be trea...
...reatment for antibiotic-resistant bacteria...
...venous acyclovir should be added to...
...should be obtained, and skin lesions in thi...
...sensitivity of a single serum fungal antige...
...lymerase chain reaction (PCR) in peripheral...
...ellular Immunodeficiency
...iate consultation with a dermatologis...
...y and surgical debridement early in th...
...antibiotics, antifungals and/or antivirals s...
...of specific agents should be decided wit...
...1. Antimicrobial therapy for Stap...
...eatment of Necrotizing Infections of the Sk...
...otics for Treatment of Incisional Surgica...
...4. Recommended Therapy for Infections after Ani...
...andard Doses of Antifungal AgentsHaving trouble v...
...ble 6. Standard Doses of Antimicrobial Ag...