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Î Biopsy or aspiration of the lesion to obtain material for histologic and
microbiologic evaluation should always be implemented as an early
diagnostic step (SR-H).
Fever and Neutropenia
Î Determine whether the current presentation of fever and neutropenia
is the patient's initial episode of fever and neutropenia or a persistent
unexplained fever from their initial episode (after 4-7 days), or a
subsequent episode of fever and neutropenia (recurrent) (SR-L).
Î Aggressively determine the etiology of the SSTI by aspiration and/or
biopsy of skin and soft tissue lesions and submit these for thorough
cytologic/histologic assessments, microbial staining and cultures
(SR-L).
Î Risk-stratify patients with fever and neutropenia according to
susceptibility to infection: high-risk patients are those with
anticipated prolonged (>7 days) and profound neutropenia
(ANC <100 cells/μL) or with a Multinational Association for
Supportive Care (MASCC) score of <21; low-risk patients are
those with anticipated brief (<7 days) periods of neutropenia and
few comorbidities (SR-L) or with a MASCC of ≥21 (SR-M).
Î Determine the extent of infection through a thorough physical
examination, blood cultures, chest radiograph and additional imaging
(including chest CT) as indicated by clinical signs and symptoms (SR-L).
Initial Antibiotic Therapy
Î Hospitalization and empiric antibacterial therapy with vancomycin
plus antipseudomonal antibiotics such as cefepime, a carbapenem
(imipenem-cilastatin or meropenem or doripenem) or piperacillin-
tazobactam are recommended (SR-H).
Î Documented clinical and microbiologic SSTIs should be treated based
on antimicrobial susceptibilities of isolated organisms (SR-H).
Î The treatment duration for most bacterial SSTIs should be 7-14 days
(SR-M).
Î Surgical intervention is recommended for drainage of soft-tissue
abscess after marrow recovery or for a progressive polymicrobial
necrotizing fasciitis or myonecrosis (SR-L).
Î Adjunct colony-stimulating factor therapy (G-CSF, GM-CSF) or
granulocyte transfusions are NOT routinely recommended (WR-M).
Î Acyclovir should be administered to patients suspected or confirmed
to have cutaneous or disseminated herpes simplex (HSV) or varicella
zoster virus (VZV) infection (SR-M).
