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
...atment...
...tigo and Ecthyma...
...culture of the pus or exudates from skin lesions...
...eatment without these studies is rea...
...of bullous and nonbullous impetigo shou...
...herapy for ecthyma or impetigo sho...
...aureus isolates from impetigo and ecthym...
...c antimicrobials should be used for infecti...
...nagement of SSTI Infections...
...rulent SSTIs (cutaneous abscesses, furu...
...culture of pus from carbuncles and absce...
...culture of pus from inflamed epidermoid cysts are...
...cision and drainage is the recommended treatment f...
...e decision to administer antibiotics...
...active against MRSA is recommended for pat...
...urrent Skin Absce...
...recurrent abscess at a site of prev...
...bscesses should be drained and cultured...
...cultures of recurrent abscess, treat with a...
...nsider a 5-day decolonization regimen of intrana...
...ients should be evaluated for neutrophil d...
...las and Cellulitis...
...d or cutaneous aspirates, biopsies,...
...of blood are recommended, (SR, M)2188...
...ltures and microscopic examination of c...
...of cellulitis without systemic signs of in...
...tis with systemic signs of infection (See F...
...patients whose cellulitis is associated with pen...
...rely compromised patients as define...
...ycin plus either piperacillin-tazobac...
The recommended duration of antimicrobi...
...f the affected area and treatment of pred...
...extremity cellulitis, clinicians should...
...t therapy is recommended for patients who do...
...alization is recommended if there...
...nflammatory Agents for Cellu...
...corticosteroids (eg, prednisone 40 mg dail...
...ecurrent Cellulit...
...d treat predisposing conditions such as...
...ctices should be performed as part of routine pat...
...ation of prophylactic antibiotics, such as o...
This program should be continued so lon...
...ound Infection Algorithm...
...gical Site Infection...
...al plus incision and drainage shoul...
...unctive systemic antimicrobial therapy is N...
...f systemic antimicrobial therapy is indic...
...rst-generation cephalosporin or an anti-staphyloc...
...tive against Gram-negative bacteria a...
...g Fasciitis, Including Fournier's Gangre...
...rgical consultation is recommended for...
...antibiotic treatment should be broad...
...s clindamycin is recommended for treatment of...
...yomyositis...
Magnetic resonance imaging (MRI) is the recommend...
...tures of blood and abscess materia...
...ncomycin is recommended for initial...
Cefazolin or antistaphylococcal penicillin (eg,...
...arly drainage of purulent material should be...
...eat imaging studies should be performed in pati...
...ld be administered intravenously initially, b...
...ostridial Gas Gangrene or Myonec...
...ent surgical exploration of the suspected gas...
...n the absence of a definitive etiologic diag...
...antimicrobial therapy with penicillin a...
...xygen (HBO) therapy is NOT recommen...
...reemptive Antimicrobial Therapy to Prevent Inf...
...rly antimicrobial therapy for 3-5 days is recomm...
...re prophylaxis for rabies may be indicate...
...d Animal Bite Wounds
...bial agent or agents active agains...
...d should be administered to patients without...
...Closure for Animal Bite Wounds...
...closure is NOT recommended for wounds...
...s may be approximated. (WR, L)21881...
Cutaneous Anthra...
...enicillin V 500 mg qid for 7-10 days is th...
...0 mg PO bid or levofloxacin 500 mg I...
...Scratch Disease and Bacillary Angiomatosis...
...is recommended for cat scratch disease...
...45 kg, 500 mg on day 1 followed by 250 mg for...
Patients
...00 mg qid or doxycycline 100 mg bid for...
...sipeloid...
...500 mg qid or amoxicillin 500 mg ti...
Glanders
...tazidime, gentamicin, imipenem, doxycycline o...
...ubonic Plag...
...c plague should be diagnosed by Gram stain and c...
...treptomycin 15 mg/kg IM q12h or doxycy...
...n could be substituted for streptomycin. (W...
...ularem...
...ogic tests are the preferred method...
...5 mg/kg q12h IM or gentamicin 1.5 mg/kg q8h...
...cline 500 mg qid or doxycycline 100 mg b...
...otify the microbiology laboratory if tularemia i...
Immunocompromised Patien...
...n to infection, differential diagnosi...
...ifferential diagnosis for infection of skin les...
...y or aspiration of the lesion to obtain mater...
...r and Neutropeni...
...whether the current presentation of fever an...
...ggressively determine the etiology of th...
...y patients with fever and neutropenia accordi...
...th a MASCC of ≥21 (SR, M...
...extent of infection through a thorough physic...
...Antibiotic Therapy
...ation and empiric antibacterial therapy with va...
...ical and microbiologic SSTIs should b...
...ent duration for most bacterial SST...
...intervention is recommended for drainage of s...
...unct colony-stimulating factor therapy...
...ld be administered to patients suspe...
...rsistent or Recurrent Episode...
...molds remain the primary cause of infection-...
...tration of vancomycin or other agents wi...
.... SSTIs should be treated with an echinoc...
...h fluconazole as an acceptable alternative....
...atment should be for 2 weeks after clea...
...TIs should be treated with voriconazole...
...lternatively, lipid formulations of amphotericin B...
...izopus infections should be treated w...
...aconazole (Table 5). (SR, L)21881...
...e addition of an echinocandin could be consid...
...infections should be treated with high-dose IV v...
...nt for antibiotic-resistant bacterial or...
...ntravenous acyclovir should be added t...
...s should be obtained, and skin lesions in this...
...sensitivity of a single serum fung...
...olymerase chain reaction (PCR) in peripheral...
...ellular Immunodeficien...
...r immediate consultation with a dermato...
...iopsy and surgical debridement early...
...ric antibiotics, antifungals and/or...
The use of specific agents should be decided with...
...imicrobial therapy for Staphylococ...
...2. Treatment of Necrotizing Infecti...
...tibiotics for Treatment of Incisional Surgical Si...
Table 4. Recommended Therapy for Infections...
...Standard Doses of Antifungal AgentsHaving trouble...
Table 6. Standard Doses of Antimicrobial Age...