Skin and Soft Tissue Infections

Publication Date: July 15, 2014

Key Points

Key Points

Recently there has been a dramatic increase in the frequency and severity of skin and soft-tissue infections (SSTIs) accompanied by the emergence of resistance to many of the antimicrobial agents commonly used to treat skin and soft-tissue infections in the past.
  • 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).
Clinical evaluation of patients with SSTI aims to establish the cause and severity of infection and must take into account pathogen-specific and local antibiotic resistance patterns.

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

...eatmen...

...go and Ecthyma

...culture of the pus or exudates from skin les...

...ment without these studies is reason...

...atment of bullous and nonbullous impetigo should...

...herapy for ecthyma or impetigo should...

...us isolates from impetigo and ecthyma...

...ic antimicrobials should be used for infect...


...Management of SSTI Infections...


...s (cutaneous abscesses, furuncles,...

...ulture of pus from carbuncles and...

...d culture of pus from inflamed epid...

...and drainage is the recommended treatment for infl...

...to administer antibiotics directed against S....

...otic active against MRSA is recomme...


...ecurrent Skin Absces...

...recurrent abscess at a site of previ...

...nt abscesses should be drained and cul...

After obtaining cultures of recurrent absc...

...nsider a 5-day decolonization regimen of intrana...

...hould be evaluated for neutrophil disorders...


...rysipelas and Cell...

...blood or cutaneous aspirates, biopsies, or...

...ultures of blood are recommended, (SR...

...res and microscopic examination of cutaneou...

...ypical cases of cellulitis without systemic sign...

For cellulitis with systemic signs o...

...whose cellulitis is associated with penetrating...

...n severely compromised patients as defin...

...mycin plus either piperacillin-tazobactam or imipe...

...ded duration of antimicrobial therapy is 5...

...he affected area and treatment of p...

...mity cellulitis, clinicians should caref...

...utpatient therapy is recommended for patien...

...zation is recommended if there is concern for a de...


...inflammatory Agents for Cellulitis...

...rticosteroids (eg, prednisone 40 mg...


...ent Cellulitis...

...y and treat predisposing conditions such as e...

...should be performed as part of routine...

...stration of prophylactic antibiotics, such as oral...

...should be continued so long as the predispos...

...ure 2. Wound Infection Algorith...


...cal Site Infections...

...lus incision and drainage should be p...

...systemic antimicrobial therapy is NOT routinel...

...rse of systemic antimicrobial thera...

...ation cephalosporin or an anti-sta...

...ents active against Gram-negative ba...


...ng Fasciitis, Including Fournier's Ga...

...surgical consultation is recommended...

...ntibiotic treatment should be broad (eg, vancomyci...

...plus clindamycin is recommended for treatment of...


...yomyositis...

...c resonance imaging (MRI) is the re...

...ures of blood and abscess material shoul...

...is recommended for initial empiric therapy. A...

Cefazolin or antistaphylococcal penicillin (eg,...

...y drainage of purulent material sho...

...aging studies should be performed in patients wit...

...ld be administered intravenously initially, but...


...lostridial Gas Gangrene or Myo...

...ent surgical exploration of the suspec...

...nce of a definitive etiologic diagnosis, broad...

...itive antimicrobial therapy with penici...

...rbaric oxygen (HBO) therapy is NOT recommende...


...timicrobial Therapy to Prevent Infection for...

...rly antimicrobial therapy for 3-5 days...

...prophylaxis for rabies may be indicated. Consu...


...ted Animal Bite Wounds...

...icrobial agent or agents active against both...

...oxoid should be administered to pat...


...ary Wound Closure for Animal Bite Woun...

...wound closure is NOT recommended...

...ther wounds may be approximated. (WR, L)2188...


Cutaneous Ant...

...penicillin V 500 mg qid for 7-10 days is the re...

Ciprofloxacin 500 mg PO bid or levofloxacin...


...atch Disease and Bacillary Angiomatosis...

...s recommended for cat scratch disease (SR, M)ac...

...kg, 500 mg on day 1 followed by 250 mg for 4...

...tients

...mycin 500 mg qid or doxycycline 100 mg bid for...


...rysipeloid

...500 mg qid or amoxicillin 500 mg t...


...anders...

...idime, gentamicin, imipenem, doxycycline or cipro...


...onic Plague...

Bubonic plague should be diagnosed by Gram st...

...15 mg/kg IM q12h or doxycycline 100 mg...

...entamicin could be substituted for streptomycin....


...aremia...

...s are the preferred method of diag...

...eptomycin 15 mg/kg q12h IM or gentamicin 1.5 mg/k...

...line 500 mg qid or doxycycline 100 mg bid P...

...icrobiology laboratory if tularemia is suspecte...


...ompromised Patients...

...nfection, differential diagnosis of skin l...

...iagnosis for infection of skin lesions sh...

...y or aspiration of the lesion to obta...


...nd Neutropenia...

...rmine whether the current presentati...

...ggressively determine the etiology of the S...

...tratify patients with fever and neutrop...

...C of ≥21 (SR, M)21881...

...extent of infection through a thorough ph...


...nitial Antibiotic The...

...alization and empiric antibacterial therapy...

...ented clinical and microbiologic SSTI...

...atment duration for most bacterial SSTIs should...

...ntion is recommended for drainage of soft-...

...junct colony-stimulating factor therapy (G-CSF,...

...ir should be administered to patients suspect...


...t or Recurrent Episodes...

...molds remain the primary cause of infectio...

...piric administration of vancomycin or other...

...Is should be treated with an echinocandin...

with fluconazole as an acceptable alternative. (...

...nt should be for 2 weeks after clearance of blood...

...lus SSTIs should be treated with voriconazole....

...ernatively, lipid formulations of am...

.../Rhizopus infections should be treated with...

...saconazole (Table 5). (SR,...

...addition of an echinocandin could be considered...

...p. infections should be treated with high...

...tment for antibiotic-resistant bacter...

...avenous acyclovir should be added to the patien...

...ood cultures should be obtained, and skin l...

...ivity of a single serum fungal antigen test (...

...in reaction (PCR) in peripheral blood...


...ellular Immunodeficienc...

...mediate consultation with a dermatologist...

...biopsy and surgical debridement early in th...

...tibiotics, antifungals and/or antiv...

...use of specific agents should be de...


...ntimicrobial therapy for Staphylococca...


...2. Treatment of Necrotizing Infect...


...iotics for Treatment of Incisional Surgical Site...


.... Recommended Therapy for Infections after...


...ble 5. Standard Doses of Antifungal Ag...


...le 6. Standard Doses of Antimicrobial Agents...