Key Points
Î Recently there has been a dramatic increase in the frequency and
severity of skin and soft-tissue infections (SSTIs) accompanied by
the emergence of resistance to many of the antimicrobial agents
commonly used to treat skin and soft-tissue infections in the past.
• There was a 29% increase in the total hospital admissions for these infections
between 2000 and 2004.
• 6.3 million physician's office visits per year are attributable to SSTIs.
• Between 1993 and 2005, annual emergency department visits for SSTIs increased
from 1.2 million to 3.4 million patients.
▶ Some of this increased frequency is related to the emergence of community
associated methicillin-resistant S. aureus (MRSA).
Î Clinical evaluation of patients with SSTI aims to establish the cause
and severity of infection and must take into account pathogen-specific
and local antibiotic resistance patterns.
Î When developing an adequate differential diagnosis and an
appropriate index of suspicion for specific etiological agents it is
essential to obtain a careful history that includes information about
the patient's immune status, geographical locale, travel history, recent
trauma or surgery, previous antimicrobial therapy, lifestyle, hobbies,
and animal exposure or bites.
Î Recognition of the physical examination findings and understanding
the anatomical relationships of skin and soft tissue are crucial for
establishing the correct diagnosis.
Î When information from history and physical are insufficient, biopsy or
aspiration of tissue may be necessary, and radiographic procedures
may be critical to determine the level of infection and the presence of
gas, abscess or a necrotizing process.
Î Surgical exploration or debridement is an important diagnostic as well
as therapeutic procedure in patients with necrotizing infections or
myonecrosis.
