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
...Treatme...
...Impetigo and...
...nd culture of the pus or exudates from skin le...
...ut treatment without these studies is...
...llous and nonbullous impetigo should...
...for ecthyma or impetigo should be a 7-d...
Because S. aureus isolates from impetigo and ec...
...icrobials should be used for infections du...
...1. Management of SSTI Infection...
...Purulent SSTIs (c...
...nd culture of pus from carbuncles...
...in and culture of pus from inflamed epider...
...on and drainage is the recommended trea...
...ision to administer antibiotics directe...
...ibiotic active against MRSA is recomme...
...current abscess at a site of previous i...
...nt abscesses should be drained and cultured early...
...r obtaining cultures of recurrent abscess...
...er a 5-day decolonization regimen of...
...dult patients should be evaluated f...
...Erysipelas and...
...es of blood or cutaneous aspirates, biopsies, or...
...blood are recommended, (SR, M)21881...
...and microscopic examination of cutaneous a...
...of cellulitis without systemic signs of infecti...
...litis with systemic signs of infection (See Fig...
...s whose cellulitis is associated with...
...romised patients as defined above (See Fig...
...mycin plus either piperacillin-tazob...
...ded duration of antimicrobial therapy is...
Elevation of the affected area and treat...
...ity cellulitis, clinicians should carefully examin...
...herapy is recommended for patients who do not...
...italization is recommended if there is concer...
...Anti-infl...
...steroids (eg, prednisone 40 mg dai...
...Recurrent Cel...
...treat predisposing conditions such as ed...
...ctices should be performed as part of rout...
...ation of prophylactic antibiotics, such as...
...m should be continued so long as the pre...
...2. Wound Infection Algorithm...
...Surgical Site Infec...
...oval plus incision and drainage should be pe...
...ctive systemic antimicrobial therapy is NOT ro...
A brief course of systemic antimicrobial therapy...
...irst-generation cephalosporin or an a...
...gents active against Gram-negative bacteria and a...
...Necrotizing Fas...
...l consultation is recommended for...
...otic treatment should be broad (eg, vancomycin or...
...clindamycin is recommended for treatment of do...
...Pyomyositis...
...gnetic resonance imaging (MRI) is the recommende...
...of blood and abscess material should be obtai...
...ncomycin is recommended for initial e...
...azolin or antistaphylococcal penicill...
...ge of purulent material should be...
...aging studies should be performed in patients wi...
...should be administered intravenous...
...t surgical exploration of the suspect...
...n the absence of a definitive etiologic di...
...ntimicrobial therapy with penicillin and c...
Hyperbaric oxygen (HBO) therapy is NOT recommende...
...Preemptive Antimicro...
...ly antimicrobial therapy for 3-5 days is recomm...
...prophylaxis for rabies may be indicated. Cons...
...Infected Animal B...
...agent or agents active against bot...
Tetanus toxoid should be administered to pat...
...d closure is NOT recommended for wounds,...
...ther wounds may be approximated. (WR, L)21881...
...Cutaneous A...
...al penicillin V 500 mg qid for 7-10 days is the re...
...cin 500 mg PO bid or levofloxacin 500 mg...
...Cat Scratch Disea...
...thromycin is recommended for cat scratch dis...
...>45 kg, 500 mg on day 1 followed by 250 mg fo...
...tients...
...thromycin 500 mg qid or doxycycline 100 m...
...Erysipeloid...
...cillin 500 mg qid or amoxicillin 50...
...Glanders...
...me, gentamicin, imipenem, doxycycline or cipr...
...Bubonic Plague...
...nic plague should be diagnosed by Gram sta...
...15 mg/kg IM q12h or doxycycline 10...
...uld be substituted for streptomycin. (WR, L)21881...
...Tularemia...
...logic tests are the preferred method of diagnosin...
...omycin 15 mg/kg q12h IM or gentamicin 1.5 mg...
...00 mg qid or doxycycline 100 mg bid PO is...
...biology laboratory if tularemia is suspec...
...Im...
...infection, differential diagnosis of skin...
...erential diagnosis for infection of skin lesion...
...tion of the lesion to obtain mater...
...Fever and Neutropenia...
...whether the current presentation of fever a...
...etermine the etiology of the SSTI by aspirat...
...ratify patients with fever and neutropen...
...ith a MASCC of ≥21 (SR, M)...
...etermine the extent of infection thr...
...Initial Antibioti...
...n and empiric antibacterial therap...
...ted clinical and microbiologic SSTIs should be tr...
...ment duration for most bacterial SSTIs...
...ntion is recommended for drainage of so...
...stimulating factor therapy (G-CSF, GM-CSF)...
...uld be administered to patients suspected...
...Persisten...
...nd molds remain the primary cause of infe...
...stration of vancomycin or other agents...
Candida spp. SSTIs should be treated with an...
...ith fluconazole as an acceptable alte...
...ment should be for 2 weeks after clearance of...
...illus SSTIs should be treated with voric...
...ernatively, lipid formulations of ampho...
...zopus infections should be treated...
...conazole (Table 5). (SR, L)21881...
...e addition of an echinocandin could be considered...
...nfections should be treated with high-d...
Begin treatment for antibiotic-resista...
...venous acyclovir should be added to...
...d cultures should be obtained, and ski...
...e sensitivity of a single serum fungal...
...se chain reaction (PCR) in peripheral...
...Cellular Imm...
...er immediate consultation with a dermatologi...
...r biopsy and surgical debridement early in th...
...tics, antifungals and/or antivirals s...
...f specific agents should be decided with t...
...1. Antimicrobial therapy for Staphylococc...
...le 2. Treatment of Necrotizing Infection...
...tibiotics for Treatment of Incision...
...mended Therapy for Infections after Animal or H...
...able 5. Standard Doses of Antifungal Ag...
...ble 6. Standard Doses of Antimicrobial Age...