Management of Skin and Soft Tissue Infections

Management of Skin and Soft Tissue Infections: IDSA Guideline 2014 from Sun YaiCheng

IDSA Guideline 2014 for Management of Skin and Soft Tissue Infections

Clinical Infectious Diseases 2014; 59(2):147–59

Abscesses, Furuncles, Carbuncles

• I&D, Gram stain and culture of pus

Erysipelas and Cellulitis

• Mild: without systemic signs of infection (SIRS), strep.
• Moderate: with SIRS, systemic antibiotics, MSSA
• Severe: SIRS + hypotension, MRSA and strep, vancomycin + [tazocin or imipenem/meropenem]

• Outpatient therapy: for patients who do not have SIRS, altered mental status, or hemodynamic instability
• Hospitalization: deeper or necrotizing infection, poor adherence to therapy, severely immunocompromise, oroutpatient treatment failing

• prednisone 40 mg daily for 7 days could be considered in nondiabetic adult patients

Surgical Site Infections

• Suture removal plus I&D
• trunk, head and neck, or extremities: MSSA, MRSA
• axilla, GI tract, perineum, or female genital tract: [cephalosporin or fluoroquinolone] + metronidazole

Necrotizing Fasciitis, gas gangrene, Fournier Gangrene

• Urgent surgical exploration
• HBO therapy not recommended
• poly-microbial, streptococci, MRSA: vancomycin + [Tazocin or a carbapenem] or Rocephin + metronidazole
• group A strep or clostridial : PCN + clindamycin

Pyomyositis

• MRI, CT, sono
• Early drainage
• Cultures of blood and abscess
• Initial empirical therapy: vancomycin
• MSSA: cefazolin or oxacillin

Animal/Human Bite

• Tetanus toxoid
• primary wound closure: not recommended (exception; face)
• unasyn or augmentin