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
Major cutaneous abscesses Cutaneous Abscess A cutaneous abscess is a localized collection of pus in the skin and may occur on any skin surface. Symptoms and signs are pain and a tender and firm or fluctuant swelling. Diagnosis is usually... read more (> 75 cm2 including edema, erythema, and induration)
Staphylococcal scalded skin syndrome Staphylococcal Scalded Skin Syndrome Staphylococcal scalded skin syndrome is an acute epidermolysis caused by a staphylococcal toxin. Infants and children are most susceptible. Symptoms are widespread bullae with epidermal sloughing... read more , scarlet fever Scarlet fever 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 , and toxic shock syndrome Toxic Shock Syndrome (TSS) Toxic shock syndrome is caused by staphylococcal or streptococcal exotoxins. Manifestations include high fever, hypotension, diffuse erythematous rash, and multiple organ dysfunction, which... read more are skin-related consequences of bacterial infections.
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 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 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.
The following are English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Practice guidelines for the diagnosis and management of skin and soft tissue infections (2014): Update (2014) by the Infectious Diseases Society of America
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