Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics - PubMed (original) (raw)

Review

. 2018 Oct 25:11:1959-1974.

doi: 10.2147/IDR.S172366. eCollection 2018.

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Review

Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics

Hoe Nam Leong et al. Infect Drug Resist. 2018.

Abstract

Complicated skin and soft tissue infections (cSSTIs) represent the severe form of infectious disease that involves deeper soft tissues. Involvement of methicillin-resistant Staphylococcus aureus (MRSA) further complicates cSSTI with increased hospitalization, health care costs, and overall mortality. Various international guidelines provide recommendations on the management of cSSTIs, with the inclusion of newer antibiotics. This literature-based review discusses the overall management of cSSTI, including appropriate use of antibiotics in clinical practice. Successful treatment of cSSTIs starts with early and precise diagnosis, including identification of causative pathogen and its load, determination of infection severity, associated complications, and risk factors. The current standard-of-care for cSSTIs involves incision, drainage, surgical debridement, broad-spectrum antibiotic therapy, and supportive care. In recent years, the emergence of newer antibiotics (eg, ceftaroline, tigecycline, daptomycin, linezolid, etc) has provided clinicians wider options of antimicrobial therapy. Selection of antibiotics should be based on the drug characteristics, effectiveness, safety, and treatment costs, alongside other aspects such as host factors and local multidrug resistance rates. However, larger studies on newer antibiotics are warranted to refine the decision making on the appropriate antimicrobial therapy. Local Antimicrobial Stewardship Program strategies in health care settings could guide clinicians for early initiation of specific treatments to combat region-specific antimicrobial resistance, minimize adverse effects, and to improve outcomes such as reduction in Clostridium difficile infections. These strategies involving iv-to-oral switch, de-escalation to narrow-spectrum antibiotics, and dose optimization have an impact on the overall improvement of cSSTI therapy outcomes, especially in countries like Singapore that has a high disease burden.

Keywords: Singapore; antibiotics; complicated skin and soft tissue infections; methicillin-resistant Staphylococcus aureus.

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Conflict of interest statement

Disclosure HW has received consulting fees from Abbott Laboratories, Actelion, Antabio, AiCuris, Astellas, Astra-Zeneca, Bayer, Biomèrieux, Cambimune, Cerexa, Da Volterra, The European Tissue Symposium, Ferring, The Medicines Company, MedImmune, Menarini, Merck, Meridian, Motif Biosciences, Nabriva, Paratek, Pfizer, Qiagen, Roche, Surface Skins, Sanofi-Pasteur, Seres, Summit, Synthetic Biologics and Valneva; lecture fees from Abbott, Alere, Allergan, Astellas, Astra-Zeneca, Merck, Pfizer, Roche & Seres; grant support from Abbott, Actelion, Astellas, Biomèrieux, Cubist, Da Volterra, MicroPharm, Morphochem AG, Sanofi-Pasteur, Seres, Spero, Summit and The European Tissue Symposium, Merck. The authors report no other conflicts of interest in this work.

Figures

Figure 1

Figure 1

Diagnosis of complicated skin and soft tissue infections.

Figure 2

Figure 2

Nursing and postoperative care in complicated skin and soft tissue infections.

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