Skin and Soft-Tissue Infections

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. 

The conditions that may predispose a patient to the development of skin and soft-tissue infections (SSTIs) include (1) a high concentration of bacteria, (2) excessive moisture of the skin, (3) inadequate blood supply, (4) availability of bacterial nutrients, and (5) damage to the comeal layer allowing for bacterial penetration. 

The majority of SSTIs are caused by gram-positive organisms and, less commonly, gram-negative bacteria present on the skin surface. Staphylococcus aureus and Streptococcus pyogenes account for the majority of SSTIs. Community-associated methicUlin-resistant S. aureus (CA-MRSA) has recently emerged and it is often isolated in otherwise healthy patients. 

Erysipelas (Saint Anthony s fire) is an infection of the superficial layers of the skin and cutaneous lymphatics. The infection is almost always caused by -hemolytic streptococci, with S. pyogenes (Group A streptococci) responsible for most infections. 

The lower extremities are the most common sites for erysipelas. Patients often experience fln-hke symptoms (fever and malaise) prior to the appearance of the lesions. The infected area is painful, often a burning pain. Erysipelas lesions are bright red and edematous with lymphatic streaking and clearly demarcated raised margins. Leukocytosis is common, and C-reactive protein is generally elevated. 

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These antibiotics are effective in die treatment of infections caused by a wide range of gram-negative and gram-positive microorganisms. The tetracyclines are used in infections caused by Rickettsiae (Rocky Mountain spotted fever, typhus fever, and tick fevers). Tetracyclines are also used in situations in which penicillin is contraindicated, in the treatment of intestinal amebiasis, and in some skin and soft tissue infections. Oral... 

Pharmacological factors 3.4 Skin and soft tissue infections... 

Describe the epidemiology, etiology, pathogenesis, clinical manifestations, diagnostic criteria, and complications associated with skin and soft tissue infections. 

Every patient receiving antimicrobial therapy for skin and soft tissue infections must be monitored for efficacy and safety. Efficacy typically is manifested by reductions in temperature, white blood cell count, erythema, edema, and pain that begin within 48 to 72 hours. To ensure safety, dose antibiotics according to renal and hepatic function as appropriate, and monitor for and minimize adverse drug reactions, allergic reactions, and drug interactions. 

Another important necrotizing skin and soft tissue infection is clostridial myonecrosis (gas gangrene). Clostridial myonecrosis can develop spontaneously but most often occurs after trauma. Clostridium perfringens is the most common causative pathogen. 

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections. Clin Infect Dis 2005 41 1373-1406. 

Chap. 70 - Skin and Soft Tissue Infections Universal Program Number ... 

Although used as a simulant, it can cause acute bacterial meningitis, pneumonia, intraabdominal infections, enteric infections, urinary tract infections, septic arthritis, endophthalmitis, suppurative thyroiditis, sinusitis, osteomyelitis, endocarditis, and skin and soft tissue infections. There are also strains of E. coli (C17-A015) that produce lethal cytotoxins (C16-A052). ... 

Evidence-Based Recommendations for Treatment of Skin and Soft-Tissue Infections... 

See Chap. 114, Skin and Soft-Tissue Infections, authored by Douglas N. Fish, Susan L. Pendland, and Larry H. Danzinger, for a more detailed discussion of this topic. 

Hair PI, Keam S J. (2007) Daptomycin A review of its nse in the management of complicated skin and soft-tissue infections and Staphylococcus aureus bacteraemia. Drugs 67 1483-512. 

Dhawan B, Gadepalli R, Kapil A. (2009) In vitro activity of daptomycin against Staphylococcus Aureus and vancomycin-resistant Enterococcus Faecium isolates associated with skin and soft tissue infections First results from India. Diagn Microbiol Infect Dis 65 196-198. 

Widmer AF. (2008) Ceftobiprole A new option for treatment of skin and soft-tissue infections due to methicillin-resistant Staphylococcus Aureus. Clin Infect Dis 46 656-658. 

It is used for pyelonephritis, cystitis, pneumonia, pleural empyema, peritonitis, sepsis, meningitis, purulent skin and soft tissue infections, infected wounds, bums, and so on, which are caused by microorganisms that are sensitive to the dmg. Gentamicin is the dmg of choice for severe bacterial infections caused by undetermined stimuli. Synonyms of this drug are garamycin, gentacylin, ribomycin, and many others. 

A) Moderately severe to severe tonsillitis, erysipelas, scarlet fever, upper respiratory tract, and skin and soft tissue infections... 

Bacterial septicemia, respiratory tract infections, skin and soft tissue infections, intra-abdominal Infections and infections of the female pelvis and genital tract... 

Anaerobes Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess serious skin and soft tissue infections septicemia, intra-abdominal infections such as peritonitis and intra-abdominal abscess (typically resulting from anaerobic organisms resident in the normal Gl tract) infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection. 

Streptococci and staphylococci Serious respiratory tract infections serious skin and soft tissue infections septicemia (parenteral only) acute staphylococcal hematogenous osteomyelitis (parenteral only). 

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