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...
...tigo and Ecthyma...
...stain and culture of the pus or exudates fro...
...ut treatment without these studies i...
...llous and nonbullous impetigo should be with eit...
...therapy for ecthyma or impetigo should be a 7-da...
...cause S. aureus isolates from impetigo and ect...
...temic antimicrobials should be used for infe...
...1. Management of SSTI Infections...
...TIs (cutaneous abscesses, furuncles, carbuncles,...
...nd culture of pus from carbuncles and abs...
...culture of pus from inflamed epidermoid cysts...
...ion and drainage is the recommended t...
...decision to administer antibiotics directed again...
...tic active against MRSA is recommended for pat...
...urrent Skin Abscesse...
...recurrent abscess at a site of previous infec...
...abscesses should be drained and cul...
...obtaining cultures of recurrent abscess, treat w...
...y decolonization regimen of intranasal m...
...s should be evaluated for neutrophil disord...
...rysipelas and Cel...
...ltures of blood or cutaneous aspirate...
...ultures of blood are recommended, (SR,...
...nd microscopic examination of cuta...
...es of cellulitis without systemic signs of i...
...ellulitis with systemic signs of infection (See Fi...
...tients whose cellulitis is associat...
...romised patients as defined above...
...cin plus either piperacillin-tazobacta...
...mmended duration of antimicrobial therapy...
Elevation of the affected area and t...
...r extremity cellulitis, clinicians...
...therapy is recommended for patients...
...is recommended if there is concern f...
...ammatory Agents for Celluliti...
...stemic corticosteroids (eg, prednis...
...current Cellul...
...dentify and treat predisposing conditions...
...should be performed as part of routi...
...stration of prophylactic antibiotics...
...s program should be continued so long as the pre...
...re 2. Wound Infection Alg...
...gical Site Infect...
...uture removal plus incision and drainage shoul...
...temic antimicrobial therapy is NOT routi...
...ief course of systemic antimicrobial therapy is i...
...first-generation cephalosporin or a...
...active against Gram-negative bacteria and anae...
...izing Fasciitis, Including Fournier's Gangr...
...rompt surgical consultation is recom...
...iric antibiotic treatment should be...
...llin plus clindamycin is recommended...
...yomyositis...
...ic resonance imaging (MRI) is the recommen...
...blood and abscess material should be obtained. (...
...cin is recommended for initial emp...
...tistaphylococcal penicillin (eg, nafcillin or ox...
...ainage of purulent material should be performed....
...tudies should be performed in patients...
...hould be administered intravenously initially...
...stridial Gas Gangrene or Myonec...
...rgical exploration of the suspected gas g...
...f a definitive etiologic diagnosis, broad-spec...
Definitive antimicrobial therapy wi...
...ic oxygen (HBO) therapy is NOT recommended be...
...icrobial Therapy to Prevent Infecti...
...mptive early antimicrobial therapy for 3-5 d...
Postexposure prophylaxis for rabies may be indi...
...cted Animal Bite Wou...
...al agent or agents active against...
...toxoid should be administered to pat...
...y Wound Closure for Animal Bite Wounds...
...rimary wound closure is NOT recommended...
...wounds may be approximated. (WR, L)21881...
...utaneous Anthrax...
...n V 500 mg qid for 7-10 days is the recommende...
...ofloxacin 500 mg PO bid or levofloxacin 500 mg IV...
...atch Disease and Bacillary Angiomatosis...
Azithromycin is recommended for cat scratch dise...
...45 kg, 500 mg on day 1 followed by 250 m...
...tients...
Erythromycin 500 mg qid or doxycycline 100 mg...
...ysipeloid
...nicillin 500 mg qid or amoxicillin 5...
...anders...
...tamicin, imipenem, doxycycline or ciprofloxaci...
Bubonic Pl...
...ue should be diagnosed by Gram stain...
...ycin 15 mg/kg IM q12h or doxycycline 10...
...n could be substituted for streptomycin. (WR, L)21...
...ularemia
...ic tests are the preferred method of d...
...eptomycin 15 mg/kg q12h IM or gentami...
...00 mg qid or doxycycline 100 mg bid...
...crobiology laboratory if tularemia is suspe...
...unocompromised Patien...
...ion to infection, differential diagn...
...diagnosis for infection of skin lesions sh...
Biopsy or aspiration of the lesion t...
...and Neutropenia...
...ne whether the current presentation of fever and n...
...determine the etiology of the SSTI b...
...sk-stratify patients with fever an...
...a MASCC of ≥21 (SR, M)21881...
...extent of infection through a thorough physical...
...itial Antibiotic The...
...on and empiric antibacterial therapy with vanc...
...cal and microbiologic SSTIs should...
...reatment duration for most bacterial...
...ention is recommended for drainage o...
...ct colony-stimulating factor therapy (G-C...
...clovir should be administered to patients suspecte...
...or Recurrent Episodes...
...remain the primary cause of infection-ass...
...administration of vancomycin or other a...
...SSTIs should be treated with an echino...
...azole as an acceptable alternative. (SR, M)21881...
...tment should be for 2 weeks after clearance...
...SSTIs should be treated with voriconazole....
..., alternatively, lipid formulation...
...nfections should be treated with lipid formulation...
...azole (Table 5). (SR, L)218...
...f an echinocandin could be consider...
...um spp. infections should be treated with high-dos...
...ent for antibiotic-resistant bacter...
...enous acyclovir should be added to...
...d cultures should be obtained, and...
...ity of a single serum fungal antigen test (1-3 Î...
...n reaction (PCR) in peripheral blo...
...r Immunodeficienc...
...nsider immediate consultation with a d...
...sider biopsy and surgical debridement...
...otics, antifungals and/or antivirals should b...
...e of specific agents should be decided with the in...
.... Antimicrobial therapy for Staphylococcal and S...
...e 2. Treatment of Necrotizing Infections of the...
...iotics for Treatment of Incisional...
...mmended Therapy for Infections after Animal...
.... Standard Doses of Antifungal AgentsHaving tro...
...d Doses of Antimicrobial Agents Active Against...