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Review
. 2018 Apr;31(2):113-119.
doi: 10.1097/QCO.0000000000000431.

Treatment of severe skin and soft tissue infections: a review

Jason P Burnham  1 , Marin H Kollef  2
Affiliations
Review

Treatment of severe skin and soft tissue infections: a review

Jason P Burnham et al. Curr Opin Infect Dis. 2018 Apr.

Abstract

Purpose of review: To review the salient features of the management of severe skin and soft tissue infections (SSTIs), including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis.

Recent findings: For severe SSTIs, intensive care, source control, and broad-spectrum antimicrobials are required for the initial phase of illness. There is an increasing focus on the utility of rapid diagnostic tests to help in selection and de-escalation of antimicrobials for SSTIs. In addition, clinical prediction scores have shown promise in helping predict patients who do not require antimicrobials directed against methicillin-resistant Staphylococcus aureus. Immune status has been shown to be important in clinical outcomes of some, but not all types of SSTIs. The debate for benefits of intravenous immunoglobulin continues to be waged in the recent literature.

Summary: Severe SSTIs are common and their management complex due to regional variation in predominant pathogens and antimicrobial resistance patterns, as well variations in host immune responses. Unique aspects of care for severe SSTIs are discussed including the role of surgical consultation and source control. The unique features of SSTIs in immunocompromised hosts are also described.

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Conflict of interest statement

Conflicts of interest

The work was performed at Barnes-Jewish Hospital, St. Louis, Missouri.

There are no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Proposed management algorithm for necrotizing soft tissue infections.
FIGURE 2.
FIGURE 2.
Necrotizing fasciitis of the lower extremity. Retiform purpura with bullae formation (a) or rapidly spreading erythema with bullae formation (b) should prompt urgent surgical consultation. Adapted from [19].
See this image and copyright information in PMC

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References

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      ■■ The reference is of interest because it describes limitations in advanced diagnostics to help determine the cause of skin and soft tissue infections (SSTIs).

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