Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure

Abstract

Over the last 25 years, the terminology of skin and soft tissue infections, as well as their classification for optimal management of patients, has changed. The so-called and recently introduced term 'acute bacterial skin and skin structure infections' (ABSSSIs), a cluster of fairly common types of infection, including abscesses, cellulitis, and wound infections, require an immediate effective antibacterial treatment as part of a timely and cautious management. The extreme level of resistance globally to many antibiotic drugs in the prevalent causative pathogens, the presence of risk factors of treatment failure, and the high epidemic of comorbidities (e.g. diabetes and obesity) make the appropriate selection of the antibiotic for physicians highly challenging. The selection of antibiotics is primarily empirical for ABSSSI patients which subsequently can be adjusted based on culture results, although rarely available in outpatient management. There is substantial evidence suggesting that inappropriate antibiotic treatment is given to approximately 20-25% of patients, potentially prolonging their hospital stay and increasing the risk of morbidity and mortality. The current review paper discusses the concerns related to the management of ABSSSI and the patient types who are most vulnerable to poor outcomes. It also highlights the key management time-points that treating physicians and surgeons must be aware of in order to achieve clinical success and to discharge patients from the hospital as early as possible.

Keywords: acute bacterial skin and skin structure infection; appropriate antibiotic therapy; methicillin-resistant Staphylococcus aureus; poor outcome; severity; treatment failure.

Figure 1.

Distribution of skin infection types in different regions.^,– DFI, diabetic foot infection; N/A, not available; uSSSI, uncomplicated skin and skin structure infection. ^aPatients could have had ⩾1 diagnosis; wound infections refer to post-surgical and post-traumatic infections.

Figure 2.

Representative images of ABSSSI indications: (a) Infected wound, (b) Abscess and (c) Cellulitis. Images belong to the corresponding author. ABSSSI, acute bacterial skin and skin structure infection.