Bacterial skin infections can be classified as skin and soft tissue infections (SSTI) and acute bacterial skin and skin structure infections (ABSSSI). SSTI include
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Minor cutaneous abscesses
ABSSSI are complex bacterial skin infections. They include
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Major cutaneous abscesses (> 75 cm2 including edema, erythema, and induration)
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Wound infections
The primary pathogens in SSTI are Streptococcus and Staphylococcus species, including methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a common pathogen in the US. However, the proportion of cases attributed to MRSA differs substantially elsewhere in the world. Particularly because MRSA can be resistant to multiple antibiotics, recommended antibiotics for bacterial skin and soft tissue infections depend largely on local prevalence and resistance patterns of MRSA.
The Infectious Diseases Society of America's (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections recommend that mild to moderate nonpurulent ABSSSI be treated with a beta-lactam or clindamycin as presumptive coverage for streptococci. Coverage for MRSA should be considered as well in patients at risk (eg, after penetrating trauma, with suspected nasal MRSA carriage, or who use IV drugs). Purulent ABSSSI are considered severe if patients have signs of systemic toxicity (eg, fever, tachycardia, tachypnea, delirium, leukocytosis). If so, Gram stain, culture, and antibiotic therapy are recommended. The antibiotic of choice is usually vancomycin. However, several alternatives are available.
More Information
The following are English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
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Practice guidelines for the diagnosis and management of skin and soft tissue infections (2014): Update (2014) by the Infectious Diseases Society of America
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Recommendations for the management of skin and soft-tissue infections (2018): World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E) consensus conference
Drugs Mentioned In This Article
| Drug Name | Select Trade |
|---|---|
clindamycin |
CLEOCIN |
vancomycin |
VANCOCIN |
