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
...reatme...
...petigo and Ect...
...culture of the pus or exudates from...
...reatment without these studies is reason...
...of bullous and nonbullous impetigo should be with...
...l therapy for ecthyma or impetigo shoul...
...se S. aureus isolates from impetigo and ec...
...robials should be used for infections during outbr...
...Management of SSTI Infections...
...(cutaneous abscesses, furuncles, carbuncle...
...ain and culture of pus from carbuncl...
...ram stain and culture of pus from in...
...n and drainage is the recommended tre...
...he decision to administer antibiotics directed...
...biotic active against MRSA is recommended for pa...
...rrent Skin Abscesse...
...current abscess at a site of previous infe...
...ent abscesses should be drained and cultur...
...fter obtaining cultures of recurrent abscess, tr...
...-day decolonization regimen of intra...
...ult patients should be evaluated for neu...
...elas and Cellulitis
...ood or cutaneous aspirates, biopsies...
Cultures of blood are recommended, (...
...d cultures and microscopic examination of c...
Typical cases of cellulitis without s...
...with systemic signs of infection (See F...
...ose cellulitis is associated with pene...
...promised patients as defined above...
...plus either piperacillin-tazobacta...
...duration of antimicrobial therapy...
...f the affected area and treatment of p...
...extremity cellulitis, clinicians should carefully...
...t therapy is recommended for patien...
...is recommended if there is concern for a deeper...
...inflammatory Agents for Cellul...
...steroids (eg, prednisone 40 mg daily for...
...rent Cellulitis...
...fy and treat predisposing conditions such as...
...practices should be performed as pa...
...dministration of prophylactic antib...
This program should be continued so long as...
...re 2. Wound Infection Al...
...Site Infections...
...al plus incision and drainage shoul...
...ve systemic antimicrobial therapy is NOT...
...urse of systemic antimicrobial therap...
...ion cephalosporin or an anti-staphylococc...
...ve against Gram-negative bacteria and...
...ecrotizing Fasciitis, Including Fournier'...
...consultation is recommended for patients wi...
...antibiotic treatment should be broad (eg,...
...lus clindamycin is recommended for...
Pyomyositis
...resonance imaging (MRI) is the recommended...
...blood and abscess material should be obtained. (...
...is recommended for initial empiric t...
...antistaphylococcal penicillin (eg, na...
...drainage of purulent material should be perf...
...t imaging studies should be performed in patients...
...hould be administered intravenously ini...
...ial Gas Gangrene or Myonecrosis...
...nt surgical exploration of the suspected gas gan...
...he absence of a definitive etiologic diagnosis, b...
...ive antimicrobial therapy with penicil...
Hyperbaric oxygen (HBO) therapy is...
...ntimicrobial Therapy to Prevent Infection for...
...ptive early antimicrobial therapy for 3-5...
...rophylaxis for rabies may be indicated. Consulta...
...Animal Bite Wounds...
...al agent or agents active against b...
...etanus toxoid should be administer...
...und Closure for Animal Bite Wound...
...ry wound closure is NOT recommended fo...
...wounds may be approximated. (WR, L)21881...
...utaneous Anth...
...penicillin V 500 mg qid for 7-10 days is th...
...in 500 mg PO bid or levofloxacin 500 mg IV...
...atch Disease and Bacillary Angiomatosis
Azithromycin is recommended for cat scratch di...
...ents >45 kg, 500 mg on day 1 follo...
Patient...
...romycin 500 mg qid or doxycycline 100 mg bid for 2...
...ysipeloid...
...nicillin 500 mg qid or amoxicillin 500 mg...
Glande...
...zidime, gentamicin, imipenem, doxycycl...
...ubonic Plagu...
...lague should be diagnosed by Gram stain and cu...
...in 15 mg/kg IM q12h or doxycycline 100 mg bid PO i...
...ould be substituted for streptomycin. (...
...aremia...
...ests are the preferred method of diagnosing tu...
...treptomycin 15 mg/kg q12h IM or gentamici...
...500 mg qid or doxycycline 100 mg bid PO is...
...y the microbiology laboratory if tularemia i...
...mmunocompromised P...
...to infection, differential diagnosis...
...iagnosis for infection of skin lesions should inc...
...ration of the lesion to obtain material f...
...ever and Neutro...
Determine whether the current presentation of...
...sively determine the etiology of t...
...stratify patients with fever and neutropenia acc...
...C of ≥21 (SR, M)21881...
...ine the extent of infection through a...
...Antibiotic Therapy
...ation and empiric antibacterial thera...
...cumented clinical and microbiologic SSTIs should...
...reatment duration for most bacterial S...
...cal intervention is recommended for dr...
...colony-stimulating factor therapy (G-CSF,...
...cyclovir should be administered to patients susp...
...ent or Recurrent Episode...
...molds remain the primary cause of infection-a...
...mpiric administration of vancomycin or othe...
.... SSTIs should be treated with an...
...uconazole as an acceptable alternative. (SR, M)218...
...should be for 2 weeks after clearance of blood...
...STIs should be treated with voriconazo...
...ternatively, lipid formulations of amphot...
...zopus infections should be treated with li...
...r posaconazole (Table 5). (SR, L)21881...
...n of an echinocandin could be conside...
...rium spp. infections should be treated...
...treatment for antibiotic-resistant bacterial o...
...clovir should be added to the patie...
...cultures should be obtained, and skin lesi...
...of a single serum fungal antigen tes...
...chain reaction (PCR) in peripheral blo...
...Immunodeficiency...
...ediate consultation with a dermatologist fami...
...biopsy and surgical debridement ear...
...piric antibiotics, antifungals and/or antivirals s...
...he use of specific agents should be decided...
...crobial therapy for Staphylococcal and S...
...atment of Necrotizing Infections of the Skin,...
...otics for Treatment of Incisional Surgical Si...
...4. Recommended Therapy for Infection...
...tandard Doses of Antifungal AgentsHa...
...d Doses of Antimicrobial Agents Activ...