Continuous monitoring of trends in pathogen and susceptibility profiles in patients with skin and soft tissue infections (SSTIs)

Abstract

The skin is colonized by a diverse collection of microorganisms. Most microorganisms coexist with their human hosts without any complications. However, in many conditions, such as impaired host immunity and presence of virulent pathogens, skin and soft tissue infections (SSTIs) can occur [1].The most common organisms associated with SSTIs are bacteria, but other organisms such as fungi, viruses, Mycobacterium tuberculosis, and protozoa may occur [1]. The profile of predominant pathogens may vary based on geographical regions. This is most likely due to evolution of pathogens associated with environmental changes, as well as the volume of antimicrobial use in the areas to control infections in humans and animals. The inappropriate use of antimicrobial agents can cause antimicrobial resistance [2,3].The spectrum of clinical manifestations in patients with SSTIs may range from cellulitis, folliculitis, erysipelas, and abscesses, including large furuncles and carbuncles. The clinical spectrum of the SSTIs can range from mild to severe, including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis [4].Definite diagnosis of pathogens causing SSTIs is necessary for an appropriate choice of antimicrobial regimens. Definite diagnosis will require the isolation of pathogens via cultures of the skin lesions, biopsy with adequate tissues, and blood culture, among others. Isolated pathogens can be identified through specific microbiological analytic techniques such as special stains, molecular techniques, and antigen detection methodologies [1]. Immunocompromised hosts such as patients with immunodeficiencies, HIVs, cancers, and other clinical conditions can pose special diagnostic and therapeutic challenges [1].Removal of pus and necrotic tissue from the source of infection is needed. The choice of initial treatment depends on the epidemiological trends (community-or hospital-acquired infections), pathogen or pathogens involved, the virulence