Skin and skin structure infections (SSSIs), also referred to as skin and soft tissue infections (SSTIs),[1] or acute bacterial skin and skin structure infections (ABSSSIs),[2] are infections of skin and associated soft tissues (such as loose connective tissue and mucous membranes).[citation needed] Historically, the pathogen involved has most frequently been a bacterial species—always, since redescription of SSSIs as ABSSSIs—and as such, these infections require treatment by antibiotics.[citation needed]
Types
Until 2008, a distinction was made between two types: complicated SSSIs (cSSSIs) and uncomplicated SSSIs (uSSSIs),[3] which had different regulatory approval requirements.[4][needs update] Uncomplicated SSSIs included "simple abscesses, impetiginous lesions, furuncles, and cellulitis."[4] Complicated SSSIs included "infections either involving deeper soft tissue or requiring significant surgical intervention, such as infected ulcers, burns, and major abscesses or a significant underlying disease state that complicates the response to treatment."[4] The FDA further noted that "[s]uperficial infections or abscesses in an anatomical site, such as the rectal area, where the risk of anaerobic or Gram-negative pathogen involvement is higher, [were also] considered complicated infections."[4] The uncomplicated category (uSSSI) is most frequently caused by Staphylococcus aureus and Streptococcus pyogenes, whereas the complicated category (cSSSI) might also be caused by a number of other pathogens.[4][verification needed] As of 2013, the pathogen involved in cases of cSSSI were known about 40% of the time.[4][needs update][verification needed]
Diagnosis
As of 2014, physicians were reported as generally not culturing to identify the infecting bacterial pathogen during diagnosis of SSSIs[5]
Treatment
Common treatment is empirical, with choice of an antibiotic agent based on presenting symptoms and location, and further followup based on trial and error.[5][verification needed] To achieve efficacy against SSSIs, physicians most often use broad-spectrum antibiotics,[citation needed] a practice contributing to increasing prevalence of antibiotic resistance,[citation needed] a trend related to the widespread use of antibiotics in medicine in general.[citation needed] The increased prevalence of antibiotic resistance is evident in MRSA species commonly involved in SSSIs, which worsen prognoses and limit treatment options.[citation needed] For less severe infections, microbiologic evaluation using tissue culture has been demonstrated to have high utility in guiding management decisions.[5]
There is no evidence to support or oppose the use of Chinese herbal medicines in treating SSTIs.[6]
See also
References
Further reading
- Lee, Su Young; Kuti, Joseph L.; Nicolau, David P. (September 1, 2005). "Antimicrobial Management of Complicated Skin and Skin Structure Infections in the Era of Emerging Resistance". Surgical Infections. 6 (3): 283–295. doi:10.1089/sur.2005.6.283. PMID 16201938 – via liebertpub.com (Atypon).