skin infection
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Introduction
Includes infections of skin appendages.
- see skin & soft tissue infection for differential diagnosis & management
Etiology
- Staphylococcus aureus including MRSA
- beta-hemolytic Streptococcus
- bacterial skin pathogens
- viral infections
Epidemiology
- most serious infections are healthcare associated[1]
Pathology
- superficial & soft tissue bacterial infection results in cellulitis
- deeper bacterial infection results in abscess formation
- when the fascia is involved, necrotizing fasciitis may occur
- involvement of hair follicles results in folliculitis
Laboratory
Radiology
- radiography only when
- diagnosis uncertain
- necrotizing fasciitis suspected
- abscess or foreign body suspected[12]
Management
- see specific skin infection
- once weekly dalbavancin* may be an option[8][13]
- single-dose oritavancin* may be an option[8]
- cephalexin or dicloxacillin first-line empirical treatment
- clinidamycin & trimethoprim/sulfamethaxazole have similar efficacy for treatment of uncomplicated skin infection[11]
* effective against MRSA
* see ref[9] for detailed 2014 guidelines
More general terms
More specific terms
- carbuncle (carbunculosis)
- cellulitis
- cutaneous tuberculosis; includes tuberculous chancre, tuberculosis verrucosa cutis
- dermatophilosis (mud fever)
- donovanosis (granuloma inguinale, granuloma venereum)
- eczema herpeticum
- erythrasma
- folliculitis
- furuncle
- impetigo
- mucocutaneous infection
- omphalitis
- pitted keratolysis
- scabies
Additional terms
References
- ↑ 1.0 1.1 Zilberberg MD et al Epidemiology and outcomes of hospitalizations with complicated skin and skin-structure infections: Implications of healthcare- associated infection risk factors. Infect Control Hosp Epidemiol 2009 Dec; 30:1203. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19848604
- ↑ 2.0 2.1 ARUP Consult: Necrotizing Soft Tissue Infections - Complicated Skin Infections The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/necrotizing-soft-tissue-infections
- ↑ Stevens DL, Bisno AL, Chambers HF, Everett ED Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005 Nov 15;41(10):1373-406. Epub 2005 Oct 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16231249
- ↑ Noah S. A primer on topical antibiotics for the skin and eyes. J Drugs Dermatol. 2008 Apr;7(4):409-15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18459527
- ↑ Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002 Jul 1;66(1):119-24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12126026
- ↑ Hurley HJ et al. Avoidable antibiotic exposure for uncomplicated skin and soft tissue infections in the ambulatory care setting. Am J Med 2013 Dec; 126:1099 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24262724 <Internet> http://www.amjmed.com/article/S0002-9343(13)00769-9/abstract
- ↑ Kish TD1, Chang MH, Fung HB. Treatment of skin and soft tissue infections in the elderly: A review. Am J Geriatr Pharmacother. 2010 Dec;8(6):485-513 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21356502
- ↑ 8.0 8.1 8.2 Boucher HW et al. Once-weekly dalbavancin versus daily conventional therapy for skin infection. N Engl J Med 2014 Jun 5; 370:2169 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24897082 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1310480
Corey GR et al. Single-dose oritavancin in the treatment of acute bacterial skin infections. N Engl J Med 2014 Jun 5; 370:2180. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24897083 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1310422
Chambers HF. Pharmacology and treatment of complicated skin and skin- structure infections. N Engl J Med 2014 Jun 5; 370:2238. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24897088 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1405078 - ↑ 9.0 9.1 Stevens DL et al Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis. June 18, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24947530 Free full text <Internet> http://cid.oxfordjournals.org/content/early/2014/06/14/cid.ciu296.full
Stevens DL, Bisno AL, Chambers HF et al Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52. Erratum in: Clin Infect Dis. 2015 May 1;60(9):1448. Dosage error in article text. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24973422 Free Article - ↑ Prescriber's Letter 21(8): 2014 CHART: Antibiotics for MRSA Skin Infections CHART: Drug Treatment of Skin and Soft Tissue Infections GUIDELINES: Executive Summary: Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300823&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 11.0 11.1 Miller LG et al Clindamycin versus Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Infections. N Engl J Med 2015; 372:1093-1103. March 19, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25785967 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1403789
Wessels MR. Choosing an antibiotic for skin infections. N Engl J Med 2015 Mar 19; 372:1164 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25785974 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1500331 - ↑ 12.0 12.1 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
- ↑ 13.0 13.1 Walker M. Dalbavancin Protocol in ED Effective for Skin Infections. Use of long-acting IV lipoglycopeptide antibiotic also cut hospital admissions. MedPage Today. June 10, 2018 https://www.medpagetoday.com/meetingcoverage/asmmicrobe/73402
Dubrovskaya Y et al Collaborative interdisciplinary process for dalbavancin (DBV) use in emergency department as an alternative to hosp. admission. ASM Microbe 2018; Abstract Saturday 588. - ↑ Kamath RS, Sudhakar D, Gardner JG et al Guidelines vs actual management of skin and soft tissue infections in the emergency department. Open Forum Infect Dis. 2018;5:ofx188. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29354655 Free PMC Article
- ↑ Ramdass P, Mullick S, Farber HF. Viral Skin Diseases. Prim Care. 2015 Dec;42(4):517-67. dReview. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26612372
- ↑ Elkston CA, Elkston DM Bacterial Skin Infections: More Than Skin Deep. Medscape. July 19, 2021 https://reference.medscape.com/slideshow/infect-skin-6003449
- ↑ Winsett FT, Patel SG, Kelly BC. Bedside diagnostics for infections: a guide for dermatologists. Am J Clin Dermatol. 2020;21:697-709. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32562204
- ↑ Silverberg B. A Structured Approach to Skin and Soft Tissue Infections (SSTIs) in an Ambulatory Setting. Clin Pract. 2021 Feb 1;11(1):65-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33535501 PMCID: PMC7931029 Free PMC article. Review.