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Severe Skin and Soft-Tissue Infections.
Addison E Stieferman1, Patrick Mazi2, Jason P Burnham2
1Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
Seminars in Respiratory and Critical Care Medicine
|February 16, 2022
Summary
Severe skin and soft-tissue infections (SSTIs) require prompt source control and antimicrobials. Management is complex, influenced by pathogens, resistance, and host factors, with ongoing research into therapies like IV immunoglobulin.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Skin and soft-tissue infections (SSTIs) are frequent causes of hospitalization, with severe cases often necessitating intensive care.
- Necrotizing infections represent a critical subset of SSTIs demanding urgent intervention.
- Effective management hinges on source control and appropriate antimicrobial selection.
Purpose of the Study:
- To review current strategies for managing severe skin and soft-tissue infections (SSTIs).
- To discuss the role of source control, antimicrobial therapy, and adjunctive treatments.
- To highlight the impact of host factors and regional variations on clinical outcomes.
Main Methods:
- Literature review focusing on severe SSTIs, necrotizing infections, and management principles.
- Analysis of data regarding source control, antimicrobial agents, and novel therapeutic options.
- Examination of host-related factors influencing disease progression and treatment response.
Main Results:
- Early source control (surgical debridement) and effective antimicrobial therapy are crucial for reducing morbidity and mortality.
- Rapid diagnostic tests can aid in antimicrobial selection and de-escalation.
- Intravenous immunoglobulin and hyperbaric oxygen therapy are explored as adjuncts, though challenges in trial recruitment persist.
Conclusions:
- Severe SSTIs are complex, multifactorial conditions requiring a comprehensive management approach.
- Host immune status and pathogen-specific characteristics significantly influence outcomes.
- Continued research is needed to optimize treatment strategies and address antimicrobial resistance.
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