Current international and national guidelines for managing skin and soft tissue infections

Bouza, Emilio; Burillo, Almudena

doi:10.1097/qco.0000000000000814

Cited by 9 publications

(12 citation statements)

References 103 publications

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“…In addition, the United States Food and Drug Administration (FDA) provides guidance in the clinical development of systemic drugs for SSTIs, including efficacy considerations [ 185 ]. Studies to date have not established a superior antimicrobial agent in SSTIs [ 186 , 187 , 188 ]. The selection of an antimicrobial drug is typically dependent on disease presentation, local antimicrobial susceptibility patterns, and patient-centric factors (e.g., tolerance, adherence, and acquisition) [ 187 ].…”

Section: Treatmentmentioning

confidence: 99%

Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections

et al. 2023

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The pathogenic bacterium Staphylococcus aureus is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) in the United States. Most S. aureus SSTIs are caused by the epidemic clone USA300 in the USA. These infections can be serious; in 2019, SSTIs with S. aureus were associated with an all-cause, age-standardized mortality rate of 0.5 globally. Clinical presentations of S. aureus SSTIs vary from superficial infections with local symptoms to monomicrobial necrotizing fasciitis, which can cause systemic manifestations and may lead to serious complications or death. In order to cause skin infections, S. aureus employs a host of virulence factors including cytolytic proteins, superantigenic factors, cell wall-anchored proteins, and molecules used for immune evasion. The immune response to S. aureus SSTIs involves initial responders such as keratinocytes and neutrophils, which are supported by dendritic cells and T-lymphocytes later during infection. Treatment for S. aureus SSTIs is usually oral therapy, with parenteral therapy reserved for severe presentations; it ranges from cephalosporins and penicillin agents such as oxacillin, which is generally used for methicillin-sensitive S. aureus (MSSA), to vancomycin for methicillin-resistant S. aureus (MRSA). Treatment challenges include adverse effects, risk for Clostridioides difficile infection, and potential for antibiotic resistance.

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Section: Treatmentmentioning

confidence: 99%

Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections

et al. 2023

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“…Trimethoprim/sulfamethoxazole, clindamycin, linezolid or doxycycline are oral options for antibiotic treatment. The duration of treatment is usually 5–7 days but may be prolonged if clinical response is delayed [28]. The Infectious Diseases Society of America (IDSA) does not recommend drawing blood cultures in uncomplicated cellulitis [29].…”

Section: Medical Managementmentioning

confidence: 99%

Community-acquired skin and soft-tissue infections in people who inject drugs

Allaw¹,

Zakhour²,

Kanj³

2023

Current Opinion in Infectious Diseases

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Purpose of reviewThe aim of this review is to discuss the latest evidence of the epidemiology, microbiology, risk factors, diagnosis and management of community-acquired skin and soft tissue infections (SSTIs) in people who inject drug (PWID). Recent findingsSSTIs are common complications in PWID and a major cause of morbidity and mortality. Infections can range from uncomplicated cellulitis, to abscesses, deep tissue necrosis and necrotizing fasciitis. They are predominantly caused by Gram-positive pathogens in particular Staphylococcus aureus and Streptococcus species; however, toxin-producing organisms such as Clostridium botulism or Clostridium tetani should be considered. The pathogenesis of SSTI in the setting of intravenous drug use (IDU) is different from non-IDU related SSTI, and management often requires surgical interventions in addition to adjunctive antibiotics. Harm reduction strategies and education about safe practices should be implemented to prevent morbidity and mortality as well as healthcare burden of SSTI in PWID. SummaryPrompt diagnosis and proper medical and surgical management of SSTI will improve outcomes in PWID.

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“…Skin and soft tissue infections (SSTI) constitute a frequent cause of consultation in Emergency Departments (ED) [1–4,5 ▪ ], where the major decisions in their management are made. Decisions are not uniform and do not uniformly follow clinical practice guidelines in many circumstances [6 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

“…Most clinical practice guidelines either do not address the issue of etiological diagnosis or are not very precise regarding the indications, the type of samples to be sent to the microbiology service, the care that these samples should receive, the potential of the new rapid techniques and the means and form of communication between the laboratory and the requesting clinician [6 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

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How to manage skin and soft-tissue infections in the emergency department

Bouza

Burillo

Muñóz

2023

Current Opinion in Infectious Diseases

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Purpose of reviewOur purpose is to review the state-of-the-art on the management of skin and soft tissue infections (SSTI) in emergency departments (ED).Although the information is scarce, SSTI may account for 3–30% of all cases presenting to an ED, of which 25–40% require hospital admission.SSTI include very different entities in aetiology, location, pathogenesis, extension, and severity. Therefore, no single management can be applied to them all. A simple approach is to classify them as non-purulent, purulent, and necrotising, to which a severity scale based on their systemic repercussions (mild, moderate, and severe) must be added.The initial approach to many SSTIs often requires no other means than anamnesis and physical examination, but imaging tests are an indispensable complement in many other circumstances (ultrasound, computerized tomography, magnetic resonance imaging…). In our opinion, an attempt at etiological filiation should be made in severe cases or where there is suspicion of a causality other than the usual one, with tests based not only on cultures of the local lesion but also molecular tests and blood cultures.Recent findingsRecent contributions of interest include the value of bedside ultrasound and the potential usefulness of biomarkers such as thrombomodulin to differentiate in early stages the presence of necrotising lesions not yet explicit.New antimicrobials will allow the treatment of many of these infections, including severe ones, with oral drugs with good bioavailability and for shorter periods.SummaryThe ED has an essential role in managing SSTIs, in their classification, in decisions on when and where to administer antimicrobial treatment, and in the rapid convening of multidisciplinary teams that can deal with the most complex situations.

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Current international and national guidelines for managing skin and soft tissue infections

Cited by 9 publications

References 103 publications

Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections

Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections

Community-acquired skin and soft-tissue infections in people who inject drugs

How to manage skin and soft-tissue infections in the emergency department

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