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
...Treatmen...
...Impet...
...stain and culture of the pus or exudates...
...ithout these studies is reasonable in typical...
...lous and nonbullous impetigo should b...
...l therapy for ecthyma or impetigo should...
...e S. aureus isolates from impetigo and ecth...
...stemic antimicrobials should be us...
...e 1. Management of SSTI Infec...
...Pu...
...stain and culture of pus from carbuncles and a...
...ain and culture of pus from inflamed...
...and drainage is the recommended treatment...
...he decision to administer antibiotics directed...
...antibiotic active against MRSA is recommended...
...Recurrent Skin...
...recurrent abscess at a site of previous...
...abscesses should be drained and cu...
...ning cultures of recurrent abscess, treat with...
...a 5-day decolonization regimen of...
...tients should be evaluated for neutro...
...Erys...
...res of blood or cutaneous aspirates, biopsies,...
...ures of blood are recommended, (SR,...
...microscopic examination of cutaneous aspirate...
...f cellulitis without systemic signs of...
...with systemic signs of infection (See Fig....
...or patients whose cellulitis is associ...
...ly compromised patients as defined above (See Fi...
...cin plus either piperacillin-tazobactam...
...recommended duration of antimicrobial therapy i...
...f the affected area and treatment of pre...
...ty cellulitis, clinicians should car...
...tpatient therapy is recommended for patients...
...ization is recommended if there is con...
...Anti-inflammatory...
...icosteroids (eg, prednisone 40 mg daily for 7 da...
...Recurrent Cellulit...
...fy and treat predisposing condition...
These practices should be performed as part of...
...tration of prophylactic antibiotics,...
...ram should be continued so long as the predi...
...Wound Infection Algorithm...
...Surgical Sit...
...uture removal plus incision and drai...
...ctive systemic antimicrobial therapy...
...rse of systemic antimicrobial therapy is indic...
...neration cephalosporin or an anti-...
...ts active against Gram-negative bacteri...
...Necrotizing Fasciitis,...
...surgical consultation is recommended for patients...
...antibiotic treatment should be broad (...
...nicillin plus clindamycin is recommend...
...Pyomyosit...
...nance imaging (MRI) is the recommended imagin...
...of blood and abscess material should...
...s recommended for initial empiric therap...
...azolin or antistaphylococcal penicillin (eg, na...
...f purulent material should be perfor...
...aging studies should be performed in pat...
...tics should be administered intravenously init...
...Clostridial Gas Gang...
...surgical exploration of the suspect...
...he absence of a definitive etiologi...
...imicrobial therapy with penicillin...
...oxygen (HBO) therapy is NOT recommended because...
...Preempt...
...ve early antimicrobial therapy for 3-5...
...ure prophylaxis for rabies may be indicated. Consu...
...Infected Animal...
...crobial agent or agents active again...
...anus toxoid should be administered to...
...Primary Wound Cl...
Primary wound closure is NOT recommended for wo...
...nds may be approximated. (WR, L)21881...
...Cutaneous Anthrax...
...al penicillin V 500 mg qid for 7-10 days is th...
Ciprofloxacin 500 mg PO bid or levofloxacin 50...
...Cat Scratch Dise...
...mycin is recommended for cat scratch dis...
...g, 500 mg on day 1 followed by 250 mg for 4...
...tients...
...in 500 mg qid or doxycycline 100 mg bid for...
...Erysipeloid...
...mg qid or amoxicillin 500 mg tid for 7-10 d...
...Glan...
...e, gentamicin, imipenem, doxycycline or cip...
...Bubo...
...ic plague should be diagnosed by Gram stain...
...cin 15 mg/kg IM q12h or doxycycline 100...
...entamicin could be substituted for streptomy...
...Tularemia...
...ests are the preferred method of di...
...15 mg/kg q12h IM or gentamicin 1.5 m...
...00 mg qid or doxycycline 100 mg bid PO is...
...crobiology laboratory if tularemia is suspected....
...Immunocompromised Pat...
...to infection, differential diagnosis of...
...ential diagnosis for infection of skin les...
...piration of the lesion to obtain material for his...
Fever...
...ne whether the current presentatio...
...essively determine the etiology of...
...tratify patients with fever and neutropenia ac...
...ith a MASCC of ≥21 (SR, M)21...
...mine the extent of infection through a thoroug...
...Initial Antibi...
...and empiric antibacterial therapy with vancomycin...
...ted clinical and microbiologic SSTIs should be tre...
...ment duration for most bacterial SST...
...intervention is recommended for drainage...
...olony-stimulating factor therapy (G-CSF, GM-CSF...
...should be administered to patients suspected or...
...Persistent or Recu...
...and molds remain the primary cause of infe...
...c administration of vancomycin or other agents wi...
...SSTIs should be treated with an echino...
with fluconazole as an acceptable altern...
...nt should be for 2 weeks after clearance of bl...
...rgillus SSTIs should be treated wi...
...ely, lipid formulations of amphotericin B, posaco...
...ucor/Rhizopus infections should be treate...
...ole (Table 5). (SR, L)21881...
...n of an echinocandin could be consid...
...fections should be treated with high-...
...gin treatment for antibiotic-resistant bac...
...ous acyclovir should be added to the pat...
...cultures should be obtained, and skin lesions in t...
...ty of a single serum fungal antigen test (1-...
Polymerase chain reaction (PCR) in peripher...
...ider immediate consultation with a derm...
...sider biopsy and surgical debridement...
...otics, antifungals and/or antivirals should be co...
...cific agents should be decided with the i...
...icrobial therapy for Staphylococcal...
...tment of Necrotizing Infections of...
...iotics for Treatment of Incisional Surgica...
...4. Recommended Therapy for Infections...
.... Standard Doses of Antifungal Agents...
...ard Doses of Antimicrobial Agents...