Skin and skin structure infection

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

• List of cutaneous conditions
• Linezolid
• Tedizolid