Bacterial Skin and Soft Tissue Infections in Adults: A Review of Their Epidemiology, Pathogenesis, Diagnosis, Treatment and Site Of Care

Abstract

Skin and soft tissue infections (SSTIs) involve microbial invasion of the skin and underlying soft tissues. They have variable presentations, etiologies and severities. The challenge of SSTIs is to efficiently differentiate those cases that require immediate attention and intervention, whether medical or surgical, from those that are less severe. Approximately 7% to 10% of hospitalized patients are affected by SSTIs, and they are very common in the emergency care setting. The skin has an extremely diverse ecology of organisms that may produce infection. The clinical manifestations of SSTIs are the culmination of a two-step process involving invasion and the interaction of bacteria with host defences. The cardinal signs of SSTIs involve the features of inflammatory response, with other manifestations such as fever, rapid progression of lesions and bullae. The diagnosis of SSTIs is difficult because they may commonly masquerade as other clinical syndromes. To improve the management of SSTIs, the development of a severity stratification approach to determine site of care and appropriate empirical treatment is advantageous. The selection of antimicrobial therapy is predicated on knowledge of the potential pathogens, the instrument of entry, disease severity and clinical complications. For uncomplicated mild to moderate infections, the oral route suffices, whereas for complicated severe infections, intravenous administration of antibiotics is warranted. Recognition of the potential for resistant pathogens causing SSTIs can assist in guiding appropriate selection of antibiotic therapy.

Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients With Uncomplicated Cellulitis

“…This leads to considerable treatment variation among physicians based on their assessment of the severity of the infection and their preferred antibiotic regimens. Despite several expert panel recommendations and cellulitis treatment guidelines, [2][3][4][5][6][7][8][9][10][11][12][13] there are currently no clinical decision aides to assist clinicians when deciding which ED patients should be treated with oral antibiotics and which patients require intravenous (IV) therapy at first presentation.…”

Imported Skin Infections from Tropical Regions by Travelers and Immigrants to the Belgian Mosan Region

“…Sea levels are rising leading to aggravate floodings [8] . Clearly, climatic changes explain shifts in the distribution and behavior of several arthropod species and consequently of vector-borne-diseases [9][10][11][12][13] . The relationship between climatic and social factors is intricated with a variety of arthropodrelated diseases.…”

Management of sepsis: from evidence to clinical practice

“…[28][29][30] When sepsis is determined by a clear infection of an organ, the most recent guidelines published on the topic should be considered. [31][32][33][34][35][36][37][38][39] Empirical antimicrobial therapy should be composed of one or more drugs that have activity against all likely pathogens and adequate tissue penetrance. The choice of empirical therapy depends on: the patient's medical history, its origin (community or nosocomial infection), recent antibiotics assumption (previous 3 months), data on local antibiotic resistance and the presence of particular pathogens that have previously colonized or have been a source of infection for the patient.…”

“…142 If the source of infection is determined, guidelines on specific infection can be applied. [31][32][33][34][35][36][37][38][39] When causative pathogen has been identified, de-escalation should be performed by selecting the most appropriate antimicrobial agent that covers the pathogen.…”