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Overview of Bacterial Skin Infections

By

Wingfield E. Rehmus

, MD, MPH, University of British Columbia

Last full review/revision Feb 2021| Content last modified Feb 2021
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Bacterial skin infections can be classified as skin and soft tissue infections (SSTI) and acute bacterial skin and skin structure infections (ABSSSI). SSTI include

ABSSSI are complex bacterial skin infections. They include

The primary pathogens in SSTI are Streptococcus Streptococcal Infections Streptococci are gram-positive aerobic organisms that cause many disorders, including pharyngitis, pneumonia, wound and skin infections, sepsis, and endocarditis. Symptoms vary with the organ... read more Streptococcal Infections and Staphylococcus Staphylococcal Infections Staphylococci are gram-positive aerobic organisms. Staphylococcus aureus is the most pathogenic; it typically causes skin infections and sometimes pneumonia, endocarditis, and osteomyelitis... read more Staphylococcal Infections 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.

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