Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. SSTIs are a frequent clinical problem in surgical departments. In order to clarify key issues in the management of SSTIs, a task force of experts met in Bertinoro, Italy, on June 28, 2018, for a specialist multidisciplinary consensus conference under the auspices of the World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E). The multifaceted nature of these infections has led to a collaboration among general and emergency surgeons, intensivists, and infectious disease specialists, who have shared these clinical practice recommendations.

Introduction Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic. Methods A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020. Findings Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment. Conclusions During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.

Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. The update includes recent changes introduced in the management of ALCD. The new update has been further integrated with advances in acute right-sided colonic diverticulitis (ARCD) that is more common than ALCD in select regions of the world.

Students wanted further education on antibiotic prescribing, and areas of lack of confidence were found. Students overestimated the current burden of resistant bacteria and were unaware of successes in reducing MRSA infections. Educational and stewardship programmes may benefit from including more cases of diagnostic uncertainty, and highlighting successes such as MRSA prevention, as evidence for the importance of current interventions.

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In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.

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Shewanella putrefaciens is as yet rarely responsible for clinical syndromes in humans. However, a case involving multiple organs in an elderly male under treatment with appropriate steroids confirms that attention should be devoted to unusual pathogens. CASE REPORTAn 87-year-old Caucasian male who had come back a few days before from holidays on the Adriatic shore was admitted because of shivering, fever up to 39.8°C, and erysipelas of the left forearm. He complained of malaise, extreme weakness, and severe pain at the upper left extremity. No other relevant symptoms were present. There was a history of "rheumatic myalgia" (not well diagnosable) for which he was on long-term, low-dose methylprednisolone (4 mg once daily); he denied other previous illnesses of note and regular consumption of any drugs.On exam, he presented as an obese man with a typical Cushing-like face and was febrile (39°C) but hemodynamically stable. A 1.5-cm-long cutaneous-subcutaneous wound was present on the skin near the left elbow, together with erysipelas affecting the whole left forearm. Small-bubbled rattling noises were heard at the level of the left pulmonary basis. In view of the fever, immediate blood (three sets each in aerobic and anaerobic bottles) (BD BACTEC, Benex Ltd., Shannon, Ireland), urine, and stool cultures were taken. Wound exudate was not cultured, nor was skin biopsy performed. Hematological investigations revealed a white cell count of 13.9 ϫ 10 9 / liter, a hemoglobin level of 14.0 g/dl, and a platelet count of 167 ϫ 10 9 /liter. C-reactive protein was at 13.5 mg/dl (normal range, 0 to 0.5 mg/dl), and the erythrocyte sedimentation rate was 37 mm (normal range, 0 to 10 mm). Chest X-ray film showed a segmental infiltrate in the left lower lobe very close to the diaphragm muscle and consistent with pneumonia. No sputum cultures were obtained, and the stable general conditions of the patient suggested delaying a bronchoscopy in order to recover lung aspirate. The patient was given empirical antimicrobial therapy with intravenous