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. 2008 Mar;19(2):173-84.
doi: 10.1155/2008/846453.

Bacterial skin and soft tissue infections in adults: A review of their epidemiology, pathogenesis, diagnosis, treatment and site of care

Vincent Ki  1 , Coleman Rotstein
Affiliations

Bacterial skin and soft tissue infections in adults: A review of their epidemiology, pathogenesis, diagnosis, treatment and site of care

Vincent Ki et al. Can J Infect Dis Med Microbiol. 2008 Mar.

Abstract
in English, French

Skin and soft tissue infections (SSTIs) involve microbial invasion of the skin and underlying soft tissues. They have variable presentations, etiologies and severities. The challenge of SSTIs is to efficiently differentiate those cases that require immediate attention and intervention, whether medical or surgical, from those that are less severe. Approximately 7% to 10% of hospitalized patients are affected by SSTIs, and they are very common in the emergency care setting. The skin has an extremely diverse ecology of organisms that may produce infection. The clinical manifestations of SSTIs are the culmination of a two-step process involving invasion and the interaction of bacteria with host defences. The cardinal signs of SSTIs involve the features of inflammatory response, with other manifestations such as fever, rapid progression of lesions and bullae. The diagnosis of SSTIs is difficult because they may commonly masquerade as other clinical syndromes. To improve the management of SSTIs, the development of a severity stratification approach to determine site of care and appropriate empirical treatment is advantageous. The selection of antimicrobial therapy is predicated on knowledge of the potential pathogens, the instrument of entry, disease severity and clinical complications. For uncomplicated mild to moderate infections, the oral route suffices, whereas for complicated severe infections, intravenous administration of antibiotics is warranted. Recognition of the potential for resistant pathogens causing SSTIs can assist in guiding appropriate selection of antibiotic therapy.

Les infections de la peau et des tissus mous (IPTM) sont causées par une invasion microbienne de la peau et des tissus mous sous-jacents. Leur présentation, leur étiologie et leur gravité sont variables. Le défi des IPTM consiste à distinguer avec efficacité les cas qui doivent être soignés immédiatement et justifient des interventions médicales ou chirurgicales, de ceux qui sont moins graves. De 7 % à 10 % des patients hospitalisés souffrent d’une IPTM, et on les voit très souvent en soins d’urgence. La peau est dotée d’une écologie très diversifiée d’organismes qui peuvent provoquer une infection. Les manifestations cliniques des IPTM sont la culmination d’un processus en deux étapes mettant en cause l’invasion et l’interaction des bactéries avec les atteintes de l’hôte. Les signes cardinaux d’IPTM sont les caractéristiques de la réponse inflammatoire accompagnées d’autres manifestations comme la fièvre, la rapide progression des lésions et les cloques. Il est difficile de poser un diagnostic d’IPTM parce que ces infections imitent souvent d’autres syndromes cliniques. Pour améliorer la prise en charge des IPTM, il est avantageux de mettre au point une démarche de stratification de la gravité pour déterminer le foyer des soins et le traitement empirique pertinent. La sélection d’une thérapie antimicrobienne est préconisée dès que l’on connaît les pathogènes potentiels, le mode d’entrée, la gravité de la maladie et les complications cliniques. Dans le cas des complications légères à modérées sans complications, la voie orale suffit, tandis que dans le cas des infections graves accompagnées de complications, l’administration des antibiotiques par voie intraveineuse s’impose. Le fait d’admettre le risque que des pathogènes résistants soient responsables des IPTM peut orienter le choix pertinent de la thérapie antibiotique.

Keywords: Bacterial; Infections; Management; Skin.

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Figures

Figure 1
Figure 1
Diagnostic evaluation of skin and soft tissue infections (SSTIs). *As clinically indicated; †Ulcerated lesions should be cleaned and debrided before having wound base swabbed; ‡Most useful if vesicle/bullae or fluid abscess present; §Seek out bone trauma and air fluid levels; Indications –neurological deficits, vision nonassessable, proptosis/deteriorating acuity or colour/bilateral edema/ophthalmoplegia, no improvement after 24 h and swinging pyrexia not resolving within 36 h (for head only); **Only if central nervous system involvement suspected and intracranial pressure excluded. CT Computed tomography; MRI Magnetic resonance imaging
Figure 2
Figure 2
Evaluation algorithm for severity of skin and soft tissue infection (SSTI). dx Dysfunction; HR Heart rate
Figure 3
Figure 3
Body surface area – the rule of nines
See this image and copyright information in PMC

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