How to stratify patients at risk for resistant bugs in skin and soft tissue infections?

Area of Science:

• Infectious Diseases
• Microbiology
• Dermatology

Background:

• Skin and soft tissue infections (SSTIs) are increasingly caused by multidrug-resistant (MDR) bacteria.
• Methicillin-resistant Staphylococcus aureus (MRSA) is a primary cause of serious SSTIs, with evolving risk factors and blurred community- vs. hospital-acquired distinctions.
• Other MDR pathogens, including Pseudomonas aeruginosa, Acinetobacter species, and vancomycin-resistant Enterococcus, are significant in complex SSTIs.

Purpose of the Study:

• To describe strategies for stratifying patients with SSTIs based on their risk for infection with MDR pathogens.
• To inform clinical decision-making regarding empirical antibiotic therapy for SSTIs.

Main Methods:

• Review of current literature on MDR pathogens in SSTIs.
• Analysis of evolving risk factors and susceptibility patterns.
• Discussion of clinical implications for empirical treatment.

Main Results:

• MRSA is a predominant pathogen in serious SSTIs, necessitating empirical MRSA coverage in high-prevalence communities.
• MDR Gram-negative bacteria are increasingly implicated in both polymicrobial and monomicrobial SSTIs.
• Long-standing infections and prior antibiotic exposure are key risk factors for MDR bacterial SSTIs.

Conclusions:

• SSTIs caused by MDR bacteria are rising, particularly in vulnerable patient populations.
• Clinicians must recognize risk factors to effectively target antibiotic therapy for at-risk individuals.
• Stratification strategies are crucial for optimizing treatment of SSTIs caused by resistant pathogens.