Severe Skin and Soft-Tissue Infections

Stieferman, Addison E; Mazi, Patrick B; Burnham, Jason P.

doi:10.1055/s-0041-1740974

Cited by 6 publications

(2 citation statements)

References 55 publications

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“…The most widespread recommendation is to perform surgery within 12 h of admission to ensure prompt treatment [50,66,67 ▪ ]. It is crucial to act quickly, as delayed surgical intervention is associated with higher comorbidities and mortality rates [68–70,71 ▪▪ ]. Even though patients requiring source control may have more severe illnesses, studies have shown that source control is associated with reduced mortality and length of stay [70,72].…”

Section: Introductionmentioning

confidence: 99%

Current challenges in acute bacterial skin infection management

Burillo,

Pulido-Pérez,

Bouza

2024

Current Opinion in Infectious Diseases

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Purpose of review There are aspects of skin and soft tissue infections (SSTIs) that remain unresolved, such as current numbers, classification criteria, how best to define severity and predict the outcome, what diagnostic tests to perform, what new treatment options are available, or what the duration of antibiotic treatment should be. We have reviewed the literature over the last 18 months to clarify these issues and provide our opinion. Recent findings SSTIs are common and among the top 10 most frequent infections worldwide. They represent a burden on the healthcare system and have a major impact on the quality of life of patients. Regarding classification, the Infectious Diseases Society of America (IDSA) provides a practical guide that distinguishes between uncomplicated and complicated infections, acute and chronic wound infections, and necrotising and nonnecrotizing infections based on skin extension and tissue necrosis. With new microbiological and imaging diagnostic techniques, SSTIs can now be better diagnosed. New PCR techniques are available, and mass spectrometry can be applied to samples collected in liquid transport media. Moreover, new treatment methods such as photodynamic therapy, reactive oxygen, and phages are emerging. SSTI patients can be treated with shorter antibiotic courses if they receive an active drug with good tissue penetration. Antibiotic treatment in necrotizing infections can be shortened to 48 h after the last debridement. Summary SSTIs remain a challenge regarding rapid and accurate diagnosis and clinical management.

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Section: Introductionmentioning

confidence: 99%

Current challenges in acute bacterial skin infection management

Burillo,

Pulido-Pérez,

Bouza

2024

Current Opinion in Infectious Diseases

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“…The immune status of some patients has been shown to be important in the clinical outcomes of some, but not all, types of SSTIs. The debate regarding the benefits of intravenous immunoglobulin continues to be waged in recent literatures [ 6 ].…”

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confidence: 99%

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

2023

Asian Biomedicine

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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

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The ever‐changing microenvironment of Staphylococcus aureus in cutaneous infections

Zhou,

Tian,

et al. 2024

Anim Models and Exp Med

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BackgroundStaphylococcus aureus is responsible for the majority of skin and soft tissue infections, which are often diagnosed at a late stage, thereby impacting treatment efficacy. Our study was designed to reveal the physiological changes at different stages of infection by S. aureus through the combined analysis of variations in the skin microenvironment, providing insights for the diagnosis and treatment of S. aureus infections.MethodsWe established a murine model of skin and soft tissue infection with S. aureus as the infectious agent to investigate the differences in the microenvironment at different stages of infection. By combining analysis of the host immune status and histological observations, we elucidate the progression of S. aureus infection in mice.ResultsThe results indicate that the infection process in mice can be divided into at least two stages: early infection (1–3 days post‐infection) and late infection (5–7 days post‐infection). During the early stage of infection, notable symptoms such as erythema and abundant exudate at the infection site were observed. Histological examination revealed infiltration of numerous neutrophils and bacterial clusters, accompanied by elevated levels of cytokines (IL‐6, IL‐10). There was a decrease in microbial alpha diversity within the microenvironment (Shannon, Faith's PD, Chao1, Observed species, Simpson, Pielou's E). In contrast, during the late stage of infection, a reduction or even absence of exudate was observed at the infected site, accompanied by the formation of scabs. Additionally, there was evidence of fibroblast proliferation and neovascularization. The levels of cytokines and microbial composition gradually returned to a healthy state.ConclusionThis study reveals synchrony between microbial composition and histological/immunological changes during S. aureus‐induced SSTIs.

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Severe Skin and Soft-Tissue Infections

Cited by 6 publications

References 55 publications

Current challenges in acute bacterial skin infection management

Current challenges in acute bacterial skin infection management

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

The ever‐changing microenvironment of Staphylococcus aureus in cutaneous infections

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