Complicated Skin and Soft Tissue Infection

Publication Date: November 1, 2009

Key Points

Key Points

Complicated infections are:

  • Those involving deeper soft tissues necessitating surgical intervention, such as infected ulcers, burns, major abscesses, or an underlying disease state that complicates the response to treatment (eg, peripheral arterial disease, chronic kidney disease, diabetes mellitus)
OR
  • Superficial infections or abscesses in sites, such as the rectal area, where the risk of anaerobic or gram-negative pathogen involvement is higher.
Skin and soft tissue infections are caused by a variety of pathogens, including aerobic gram-positive and gram-negative organisms, as well as certain unique pathogens acquired in specific settings.
  • Overall, Staphylococcus aureus is the pathogen most frequently isolated from complicated SSTIs.
In many regions and communities, a rapid rise in CA-MRSA has occurred, with this organism now being the single most frequent pathogen in SSTIs.
  • This pathogen typically is associated with the production of virulence factors not common to methicillin-sensitive S. aureus (MSSA) isolates or to hospital-associated HA-MRSA isolates, including the Panton-Valentine leukocidin (PVL) toxin.

Assessment

Assessment

...-necrotizing Cellulitis

...lly spreading infections involving the skin are ca...

...tibiotic therapy: for moderate to se...

...ment failures may occur if β-lactam agents...

...hesis-inhibitory agents alone—eg, cl...

Increasing macrolide resistance among streptoco...

...her regimens that may be considered are ant...


...bscesses

...abscesses may respond to incision an...

...x abscesses and those with substantial cellul...

...equate response to therapy should prompt evaluatio...

...ntibiotic therapy should be directed towa...

...ents directed at CA-MRSA should be c...

...ed polymicrobial infections should be...


...ng Skin and Soft Tissue Infections...

...agnosis:...

LRINEC Score Calculator...

...diagnosis increase both the morbidity...

The presence of gas in soft tissues i...

...aphy and MRI improve the detection of soft...

...ographic findings of tissue fluid and edema...

...tures strongly suggestive of necrotizi...

...es predictive of the presence of necrotizing inf...

...eatment...

...priate antibiotic coverage of inciting pathog...

...debridement improves outcome. (1, C)687...

...omized or important non-randomized s...

...uent re-evaluation or return to the operati...

...likely pathogens differ depending on the clinic...

...g pathophysiology, and previous ex...

...infections are more frequently polymicrobia...

...t relevant pathogens are covered appro...

...ng resistance of gram-negative bacilli to ampi...

...binations of agents probably are equally effect...


...ressive Soft Tissue Infections...

...ly progressive soft tissue infections can be caus...

...infections require early and aggressive ant...

...rapy that includes protein synthesis...


Selecting a Treatment Regimen

...g a Treatment Regimen...

Figure 1. Non-Necrotizing β-Hemolytic Str...


...Complicated Abscesses...


...igure 3. Necrotizing Skin and Soft Tissue Infe...


...Staphylococcus aureus– MSSA &...


...crotizing Group A Streptococcal Infections...


.... Clostridial Infections...


...igure 7. VibrioInfecti...


...Antibiotic Treatment of Complicated SST...


...2. Organisms Recovered from 198 Consecutive Pati...