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...
...mpetigo and Ec...
...stain and culture of the pus or exudates fro...
...atment without these studies is re...
...of bullous and nonbullous impetigo sh...
...therapy for ecthyma or impetigo should be a 7-day...
...S. aureus isolates from impetigo and ecthyma are...
...microbials should be used for infections during...
...1. Management of SSTI Infection...
...rulent SSTIs (cutaneous abscesses, fur...
...in and culture of pus from carbuncles and ab...
...stain and culture of pus from inflamed epiderm...
...inage is the recommended treatment fo...
...administer antibiotics directed against S. a...
...c active against MRSA is recommended for patients...
...current Skin Absce...
...abscess at a site of previous infection sho...
...rrent abscesses should be drained and cultured e...
...obtaining cultures of recurrent ab...
...r a 5-day decolonization regimen of intranasal m...
Adult patients should be evaluated for neutr...
Erysipelas and Cellulit...
...tures of blood or cutaneous aspirate...
...of blood are recommended, (SR, M...
...res and microscopic examination of cutaneou...
...al cases of cellulitis without systemic signs o...
...r cellulitis with systemic signs of infection (Se...
...ts whose cellulitis is associated with penetrati...
...romised patients as defined above (See Fig. 1/No...
...us either piperacillin-tazobactam or imipenem/me...
...ded duration of antimicrobial therapy is...
...of the affected area and treatment of predispos...
...tremity cellulitis, clinicians should car...
...apy is recommended for patients who do n...
...n is recommended if there is concern fo...
...nti-inflammatory Agents for Cellulitis...
...icosteroids (eg, prednisone 40 mg daily...
...rent Cellulitis...
...treat predisposing conditions such as edema, obes...
...should be performed as part of routine patient c...
...tration of prophylactic antibiotics,...
...ogram should be continued so long as...
...re 2. Wound Infection Algorithm
...rgical Site Infe...
...uture removal plus incision and drainage should...
...djunctive systemic antimicrobial therapy i...
...ourse of systemic antimicrobial therapy is...
...rst-generation cephalosporin or an anti-st...
...against Gram-negative bacteria and anaerobes,...
...asciitis, Including Fournier's...
Prompt surgical consultation is reco...
...ibiotic treatment should be broad (eg, v...
...icillin plus clindamycin is recommended for tr...
...yomyositi...
...ce imaging (MRI) is the recommended...
...tures of blood and abscess material should be...
...in is recommended for initial empiric t...
...istaphylococcal penicillin (eg, nafcillin or...
...arly drainage of purulent material shoul...
...ging studies should be performed in patients with...
...s should be administered intravenously initial...
...lostridial Gas Gangrene or Myonecro...
...l exploration of the suspected gas gangrene site...
...of a definitive etiologic diagnosis, broad-...
...tive antimicrobial therapy with penicillin and...
...aric oxygen (HBO) therapy is NOT recommen...
...emptive Antimicrobial Therapy to P...
...eemptive early antimicrobial thera...
...sure prophylaxis for rabies may be indicated...
...Animal Bite Wounds...
...crobial agent or agents active against both ae...
...s toxoid should be administered to...
Primary Wound Closure for Animal Bite Woun...
...und closure is NOT recommended for wounds, w...
...unds may be approximated. (WR, L)21881
...taneous Anthr...
...illin V 500 mg qid for 7-10 days is the recom...
...acin 500 mg PO bid or levofloxacin 500 mg IV...
...isease and Bacillary Angiomatosis
...is recommended for cat scratch disease...
...>45 kg, 500 mg on day 1 followed by 250 mg for 4...
...tients...
...n 500 mg qid or doxycycline 100 mg bid for 2 weeks...
...sipeloid...
...illin 500 mg qid or amoxicillin 500 mg tid for...
...lander...
...zidime, gentamicin, imipenem, doxycycline or ci...
...bonic Plagu...
...c plague should be diagnosed by Gram s...
...treptomycin 15 mg/kg IM q12h or doxycycli...
...micin could be substituted for str...
Tularem...
...ogic tests are the preferred method...
...omycin 15 mg/kg q12h IM or gentamicin 1.5 mg/kg...
...etracycline 500 mg qid or doxycycline 100...
...biology laboratory if tularemia is suspected. (S...
...ocompromised Patient...
...on to infection, differential diagnosis of ski...
...ifferential diagnosis for infection of...
...ration of the lesion to obtain material for h...
...ver and Neutropenia...
...er the current presentation of fever an...
...ively determine the etiology of the SSTI...
...y patients with fever and neutropen...
...MASCC of ≥21 (SR, M)21881
...mine the extent of infection through a thorough...
...Antibiotic Therapy...
...alization and empiric antibacterial therap...
...ical and microbiologic SSTIs should...
...reatment duration for most bacterial SSTIs...
...rgical intervention is recommended for drainage o...
...colony-stimulating factor therapy (G-CSF, G...
...lovir should be administered to patients suspected...
...t or Recurrent Episodes...
...ts and molds remain the primary cause of infectio...
...ric administration of vancomycin or other...
...da spp. SSTIs should be treated with a...
...luconazole as an acceptable alternative. (SR,...
...should be for 2 weeks after clearance of blood str...
...rgillus SSTIs should be treated with...
...y, lipid formulations of amphotericin B, posacon...
...izopus infections should be treated...
...azole (Table 5). (SR, L)2188...
...an echinocandin could be considered based o...
...pp. infections should be treated wit...
...nt for antibiotic-resistant bacteri...
...s acyclovir should be added to the patien...
...cultures should be obtained, and sk...
...ensitivity of a single serum fungal antigen tes...
...ymerase chain reaction (PCR) in peripheral...
...Immunodeficiency...
...r immediate consultation with a dermatologist f...
Consider biopsy and surgical debrid...
...iric antibiotics, antifungals and/or antiviral...
...use of specific agents should be decided with th...
...ble 1. Antimicrobial therapy for Staphyl...
...2. Treatment of Necrotizing Infections of th...
...iotics for Treatment of Incisional Surgical S...
...ecommended Therapy for Infections after Animal or...
...5. Standard Doses of Antifungal AgentsHaving...
...tandard Doses of Antimicrobial Agents Active...