Bacterial infection of the skin

Bacterial infection of the skin and subcutaneous tissue can lead to rapidly spreading inflammation known as cellulitis, which requires systemic antibacterial treatment. Treatment is usually with benzylpenicillin and flucloxacillin or erythromycin. 

Impetigo on small areas of skin can be treated with topical application of fusidic acid. Extensive impetigo needs treating with a systemic antibacterial such as flucloxacillin. 

There are many topical antibacterials available. In order to minimize the development of resistant bacteria, their use should be limited to those that are not used systemically. 

Silver sulfadiazine, 1% cream, was recently added to the list of prescription-only medicines that qualified, registered podiatrists can access and supply. Silver sulfadiazine 

The skin is the largest organ of the body and forms a barrier between the external environment and the internal organs of the body. The skin is subject to trauma and damage. Common skin disorders are eczema, psoriasis and infection. 

---

Cellulitis and erysipelas are bacterial infections of the skin. Although separate entities, there is some clinical difficulty in distinguishing the two. 0 Cellulitis is a bacterial infection of the dermis and subcutaneous tissue, whereas erysipelas is a more superficial infection of the upper dermis and superficial lymphatics. Although both can occur on any part of the body, about 90% of infections involve the leg.8,9 Another 7.5% of cases involve the arm or face. Erysipelas is most common in the young and the elderly. Typically, both infections develop after a break in skin integrity, resulting from trauma, surgery, ulceration, burns, tinea infection, or other skin disorder. 

Chiller K, Selkin BA, Murakawa GJ Skin microflora and bacterial infections of the skin. J Investig Dermatol 2001 6 170-174. 

Bacterial infections of the skin can be classified as primary or secondary (Table 47-1). Primary bacterial infections are usually caused by a single bacterial species and involve areas of generally healthy skin (e.g., impetigo, erysipelas). Secondary infections, however, develop in areas of previously damaged skin and are frequently polymicrobic. 

As stated earlier, antiseptic cleaning may be useful in prevention of bacterial infections of the skin, but a prophylactic effect of antiseptics for prevention of eczema has not been shown yet. Due to their mostly irritative and sometimes allergic potential, antiseptics rather deteriorate the skin barrier of intact skin by degreasing the lipid barrier. In addition, they probably enhance susceptibility of dry skin for irritants more than they protect.17 Late onset hypersensitivity and eczema occur regularly and are well-documented events. 

Rhody, C., Bacterial infections of the skin. Prim. Care 27, 459-473, 2000. 

Bochud-Gabellon I, Regamey C. Teicoplanin, a new antibiotic effective against Gram-positive bacterial infections of the skin and soft tissues. Dermatologica 1988 176(l) 29-38. 

A number of classification schemes have been developed to describe SSTIs. Bacterial infections of the skin can be classified as primary or secondary (Table 108-1). Primary bacterial infections usually involve areas of previously healthy skin and typically are caused by a single pathogen. In contrast, secondary infections occur in areas of previously damaged skin and are frequently polymicrobic. SSTIs are also classified as complicated or uncomplicated. Infections are considered complicated when they involve deeper skin structures (e.g., fascia, muscle layers, etc), require significant surgical intervention, or occur in patients with compromised immune function (e.g., diabetes mellitus, human immunodeficiency virus [HIV] infection, etc). ... 

Sadick NS. Current aspects of bacterial infections of the skin. Dermatol 36. Clin 1997 15 341-349. 

Bacterial infection of the skin causes a condition known as cellulitis, which requires systemic antibiotics. As does impetigo if it is extensive, although small patches can be treated topically. Silver sulfadiazine is used prophylactically to prevent infection in burns and other wounds and is now on the list of antibiotics that qualified registered podiatrists can access and supply. 

Deeper bacterial infections of the skin include folliculitis, erysipelas, cellulitis, and necrotizing fasciitis. Since streptococcal and staphylococcal species also are the most common causes of deep cutaneous infections, penicilUns (especially ji-lactarruise-resistant ji-lactams), and cephalosporins are the systemic antibiotics used most frequently in their treatment (see Chapter 44). A growing concern is the increased incidence of skin and soft tissue infections with hospital- and community-acquired methicillin-resistant S. aureus (MRSA) and drug-resistant pneumococci. Infection with community-acquired MRSA often is susceptible to trimethoprim—sulfamethoxazole. 

Relief of skin infedions borrheic dermatitis, seborrhea sicca (dandruff), bacterial infections of the skin... 

Bonnevie P (1948) Fishermen s Dogger Bank Itch allergic contact eczema due to coralline Alcyonidium hirsutumy Sie sea-chervil. Acta Allergol 1 40-46 Burnett JW (1962) Uncommon bacterial infections of the skin. Arch Dermatol 86 597-607... 

Preseptal celluHtis is a bacterial infection of the skin and subcutaneous tissue that may proceed into the orbit. Comphcations of infectious disease of the orbit include orbital abscess, epidural or subdural abscess of the neurocranium, purulent meningitis, and thrombosis of the cavernous sinus (Mueller-Forell and Pitz 2004). 

More then a dozen representatives of the above ring systems were introduced into the human therapy. Actisomide (2) and trequinsin (3) are used as antiarrhytmic and antihypertensive agents, respectively. Sunepitron (4), a a 2-adrenoceptor antagonist, is under clinical trials for the treatment of anxiety and depression. Representatives of the third generation of antibacterial quinolone-3-carboxylic acids the blockbluster ofloxacin (5), its levorotatory enantiomer, levofloxacin (6), and rufloxacin (7) have gained wide acceptance for the treatment of bacterial infections of the respiratory and urinary tracts, skin, and soft tissues, as well as sexually transmitted diseases, and pazufloxacin (8) is under development. Praziquantel (9) is widely applied for the treatment of schistosomes- and cestode-caused infection in both veterinary and human therapies (Scheme 4). 

Scabies is a skin infection caused by mites. Septicaemia occurs when bacterial microorganisms or their toxins enter the bloodstream. Endocarditis refers to bacterial infections of the endocardium. Peritonitis occurs when bacterial microorganisms infect the peritoneum. Shighellosis refers to infections caused by the Shighella bacteria. 

Cefalotin is used for bacterial infections of the lower respiratory tract, urinary tract, skin, soft tissues, bones and joints, sepsis, peritonitis, osteomyelitis, mastitis, infected wounds, and post-operational infections. Synonyms of this drag are ceflin, seffein, coaxin, and others. 

Bacteria commonly isolated from primary skin infections in animals include Staphylococcus spp. (a large proportion of isolates show penicillinase activity), Streptococcus spp., Proteus spp. and Escherichia coli. Prolonged exposure to wet weather and muddy conditions under foot predispose horses and ruminant animals, respectively, to skin infection caused by Dermatophilus congolensis. Bacterial infections of the foot are generally caused by Fusohacterium necrophorum and Bacteroides spp. footrot in sheep is caused by Bacteroides (Dichelobacter) nodosus. 

A complex interplay of host and pathogen factors influences the acquisition and development of fungal infections. Intact skin or mucosal surfaces serve as primary barriers to infection. Desiccation, epithelial cell turnover, fatty acid content, and low pH of the skin are believed to be important factors in host resistance. Bacterial flora of the skin and mucous membranes compete with fungi for growth. Alterations in the balance of normal flora caused by the use of antibiotics or alterations in nutritional status can allow the proliferation of fungi such as Candida, increasing the likelihood of systemic invasion and infection. ... 

Another option, the so-called full pharmacokinetic screen, is to sample at fixed times relative to dosing within a single dosing interval such as with a traditional Phase 1 study. For example, Preston et al. (1998) reported such a design in their PopPK analysis of levo-floxacin in 313 subjects with bacterial infections of the respiratory tract, skin, or urinary tract. Therein samples were collected at end of infusion, 2, 6.75, 7.75, and 9.25 h after the third intravenous dose. What made intensive sampling possible in this case was that these subjects were at the hospital already. In general, if the disease state requires hospitalization then intensive sample collection is less a problem than if the subject is treated in an out-patient manner. 

External bacterial or fungal infections As a powder liberally sprinkled on site of infection as frequently as needed, except for impetigo (staphylococcal or streptococcal infection of the skin) use the tinture full strength or 50 percent dilute tincture applied directly on site of infection with cotton swab. 

RR Marples. The effect of hydration on the bacterial flora of the skin. In HI Mai-bach, G Hildick-Smith, eds. Skin Bacteria and Their Role in Infection. New York McGraw-Hill, 1965, pp. 33-41. 

---