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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

Staphylococcal scalded skin syndrome, scarlet fever, and toxic shock syndrome are skin-related consequences of bacterial 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.

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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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