Erysipelas and cellulitis: clinical and microbiological spectrum in an Italian tertiary care hospital (original) (raw)
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Frequent bacterial skin and soft tissue infections: diagnostic signs and treatment
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2015
Skin and soft tissue infections rank among the most frequent infections worldwide. Classic erysipelas is defined as a non-purulent infection by beta-hemolytic streptococci. The typical signs are tender, warm, bright erythema with tongue-like extensions and early systemic symptoms such as fever or at least chills. Erysipelas always and best responds to penicillin. Limited soft tissue infection or limited cellulitis are the terms we have introduced for infections frequently caused by S. aureus and often originating from chronic wounds or acute trauma. Clinically, they are marked by tender, erythematous swelling which, unlike erysipelas, exhibit a darker red hue and is not always accompanied by fever or chills at onset. Severe cellulitis is a purulent, partially necrotic infection extending to the fascia, with general symptoms of infection, requiring surgical management in addition to antibiotics. It often fulfils criteria of so-called complicated soft tissue infections according to th...
BMC Infectious Diseases, 2012
Background: Complicated skin and soft tissue infections (cSSTIs) occur frequently, but limited data do not allow any consensus on an optimal treatment strategy. We designed this prospective, multicenter, observational study to to explore the current epidemiology, treatment, and resulting clinical outcomes of cSSTIs to help develop strategies to potentially improve outcomes. Methods: From June 2008 to December 2009 we enrolled a pre-specified number of adults treated in 56 U.S. hospitals with intravenous antibiotic(s) for any of the following cSSTIs: diabetic foot infection (DFI); surgical site infection (SSI); deep soft tissue abscess (DSTA); or, cellulitis. Investigators treated all patients per their usual practice during the study and collected data on a standardized form.
Expert Opinion Soft-tissue infections: An approach to diagnosis and management Corresponding Author
Soft tissue infections comprise a broad category of microbial infections, with cellulitis, abscesses, necrotizing fasciitis and gas gangrene the most frequently encountered. A comprehensive history and physical examination is crucial and can help facilitate early diagnosis and management. Diag-nostic adjuncts including laboratory and imaging studies are available and can aid the clinician in the workup. Although cellulitis and abscesses are often treated with oral antibiotics or local drainage, respectively, necrotizing fasciitis and gas gangrene represent surgical emergencies with high morbidity and mortality. This article reviews the approach to diagnosis and management of soft tissue infections.
Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections
Mayo Clinic Proceedings, 2014
The prevalence of skin and soft-tissue infections (SSTIs) has been increasing in the United States. These infections are associated with a rise in hospital admissions for management. Hospitalists have an increasingly important role in the management of these infections, utilizing hospital resources efficiently and effectively. When available, observation units are useful for treating lowrisk patients not requiring hospital admission. Imaging tools may help to exclude abscesses and necrotizing soft-tissue infections (NSTIs), however, surgical exploration remains the principal means of diagnosing NSTIs. The most common pathogens causing SSTIs are streptococci and Staphylococcus aureus. Methicillin-resistant S. aureus (MRSA) is a prevalent pathogen and concerns are rising regarding the unclear distinctions between communityacquired and hospital-acquired MRSA. Other less frequent pathogens causing SSTIs include Enterococcus spp., Escherichia coli, Klebsiella spp., Enterobacter spp., and Pseudomonas aeruginosa. Cephalexin and clindamycin are suitable options for infections caused by streptococcal spp. and methicillin-susceptible S. aureus. The rising resistance of S. aureus and Streptococcus pyogenes to erythromycin limits its use in these infections, and better alternatives are available. Parenteral cefazolin, nafcillin, or oxacillin can be used in Amin, 4 hospitalized patients with nonpurulent cellulitis caused by streptococci and methicillin-susceptible S. aureus. When oral MRSA therapy is indicated, clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or linezolid are appropriate. Vancomycin, linezolid, daptomycin, tigecycline, telavancin, and ceftaroline fosamil are intravenous options that should be used in MRSA infections that require hospitalization. In the management of patients with SSTIs, hospitalists are at the forefront of providing proper patient care that reduces hospital costs, duration of therapy, and therapeutic failures. This review updates the management of SSTIs with a focus on infections caused by S. aureus, particularly MRSA, and outlines the role of the hospitalist in the effective management of SSTIs. A PubMed search was performed from 2000 to present using the search terms SSTI, MRSA, surveillance, resistance, clinical guidelines, antimicrobials, hospitalists, and supplemented with articles under "Related citations in PubMed." Studies were selected based on clinical relevance, date published, comparative trials, and standards of practice. Amin, 5
Management of Skin and Soft-Tissue Infections in the Emergency Department
Infectious Disease Clinics of North America, 2008
Skin and soft-tissue infections (SSTIs) are among the most common infections encountered by emergency physicians. The spectrum of disease severity as seen by emergency physicians is wide, and can range from mild, uncomplicated cellulitis to cutaneous abscesses and necrotizing SSTIs. Infections can include acute, recurrent, and chronic wounds, and community-associated and health care-associated infections in immunocompetent or immunocompromised hosts. Because of the nature of their practice, emergency physicians encounter patients on a daily basis with a wide variety of mechanisms that lead to SSTIs. These can include animal and human bites, gunshot wounds, illicit drug injection, work-related injuries, pressure sores, and iatrogenic injuries caused by procedures (eg, intravenous lines). Similarly, infectious disease (ID) specialists see a variety of SSTIs in their practice; however, for the ID specialist the spectrum of disease is more skewed toward patients with a complicated course, those who had multiple treatment failures, and recurrent, severe, or rare and unusual infections. Unlike ID specialists, emergency physicians more frequently have to initiate empiric antibiotics because of the absence of culture and susceptibility results, more often have to consider life
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2019
These first German S2k guidelines for bacterial skin and soft tissue infections were developed as one chapter of the recommendations for "calculated initial parenteral treatment of bacterial infections" issued under the auspices of the Paul-Ehrlich Society, of which the main part is presented here. Well-calculated antibiotic therapies require precise diagnostic criteria. Erysipelas is defined as non-purulent infection considered to be caused by beta-hemolytic strepto cocci. It is diagnosed clinically by its bright-red erythema and early fever or chills at disease onset. Penicillin is the treatment of choice. Limited soft tissue infection (cellulitis) is usually caused by Staphylococcus (S.) aureus, frequently originates from chronic wounds and presents with a more violaceous-red hue and only rarely with initial fever or chills. Treatment consists of first-or second-generation cephalosporins or flucloxacillin (IV). Severe cellulitis is a purulent, partially necrotic infection which extends through tissue boundaries to fascias and requires surgical management in addition to antibiotics. Moreover, it frequently fulfills the criteria for "complicated soft tissue infections", as previously defined by the Food and Drug Administration for use in clinical trials (they include comorbidities such as uncontrolled diabetes, peripheral artery disease, neutropenia).
BMC infectious diseases, 2016
Skin and soft tissue infections (SSTIs) are a leading cause for hospitalizations in the United States. Few studies have addressed the appropriateness of antibiotic therapy in the management of SSTIs without complicating factors. We aimed to determine the appropriateness of antibiotic treatment duration for hospitalized adult patients with uncomplicated SSTIs. This was a retrospective analysis performed at two academic medical centers in Pittsburgh, Pennsylvania on patients aged 18 years and older with primary ICD-9 code for SSTIs admitted August 1st, 2014-March 31st, 2015. The primary outcome was the appropriateness of antibiotic treatment duration for uncomplicated SSTIs. Secondary objectives included the appropriateness of antibiotic agent spectrum, duration of inpatient length of stay (LOS), utilization of blood cultures and advanced imaging modalities, and re-hospitalization for SSTI within 30 days of discharge from the index admission. A total of 163 episodes were included in t...
Clinical Presentations of Soft‐Tissue Infections and Surgical Site Infections
Clinical Infectious Diseases, 2001
Skin and soft-tissue infections that usually follow minor traumatic events or surgical procedures are caused by a wide spectrum of bacteria. Less frequently, the infections occur spontaneously, which often is clinically confusing and leads to delays in diagnosis. Most of the infections are self-limited and easily treated with local measures and/or antibiotics. Others are life-threatening, requiring prompt diagnosis and aggressive surgical debridement in addition to the wise choice of antibiotic agents to limit tissue loss and preserve life. Many survivors experience critical tissue losses that may require changes in lifestyle as well as major reconstructive cosmetic surgery. Involvement of antibiotic-resistant gram-positive microorganisms in these infections only increases the difficulty of their treatment and may have a significant influence on the ultimate outcome.