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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss characteristics of the skin that render it resistant to infection.

  2. Describe the epidemiology, etiology, pathogenesis, clinical manifestations, diagnostic criteria, and complications associated with skin and soft tissue infections (SSTIs).

  3. Identify the desired therapeutic outcomes for patients with SSTIs.

  4. Recommend appropriate empirical and definitive antimicrobial regimens when given a diagnosis, patient history, physical examination, and laboratory findings.

  5. Monitor chosen antimicrobial therapy for safety and efficacy.

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KEY CONCEPTS

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  • Image not available. Impetigo commonly afflicts young children, is usually caused by group A streptococci or Staphylococcus aureus, and is characterized by numerous blisters that rupture and form crusts. Dicloxacillin, cephalexin, and topical mupirocin are considered the antibiotics of choice for treatment of impetigo.

  • Image not available. Folliculitis, furuncles, and carbuncles refer to the inflammation of one or more hair follicles, often attributed to infection with S. aureus. Treatment depends on severity and may involve local heat, incision and drainage, and/or oral or topical antibiotic therapy.

  • Image not available. Erysipelas is a superficial infection of the upper dermis and superficial lymphatics distinguished from cellulitis by its well-defined borders and slightly raised lesions. It is usually caused by β-hemolytic streptococci and treated with penicillin.

  • Image not available. Cellulitis, a bacterial infection of the dermis and subcutaneous tissue, is most commonly caused by S. aureus and β-hemolytic streptococci. Although β-lactams active against penicillinase-producing strains of S. aureus have historically been the drugs of choice, in areas with high rates of community-acquired methicillin-resistant S. aureus (CA-MRSA), or in patients with risk factors for CA-MRSA infection, treatment with antibiotics active against this organism should be initiated due to its increasing prevalence.

  • Image not available. Persons who are immunocompromised, have diabetes or vascular insufficiency, or use injection drugs are at risk for polymicrobial cellulitis, often requiring broad-spectrum antibiotic coverage.

  • Image not available. Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, life-threatening infection that causes necrosis of the subcutaneous tissue and fascia. Immediate surgical débridement is key to reducing its associated mortality.

  • Image not available. The pathogenesis of diabetic foot infection stems from three key factors: neuropathy, angiopathy, and immunopathy. Aerobic gram-positive cocci, such as S. aureus and β-hemolytic streptococci, are the predominant pathogens in acutely infected diabetic foot ulcers. However, chronically infected wounds are subject to polymicrobial infection and require treatment with broad-spectrum antibiotics.

  • Image not available. Prevention is key in the management of pressure sores. Mild superficial pressure sore infections may be treated with topical antimicrobial agents. Systemic antibiotics are indicated for serious pressure ulcer infections, including those associated with spreading cellulitis, osteomyelitis, or bacteremia.

  • Image not available. Bite wound infections generally are polymicrobial. Amoxicillin-clavulanate is the drug of choice for treating infected bite wounds and is also used as infection prophylaxis for human bites, deep punctures, and bites to the hand, or those requiring surgical repair.

  • Image not available. Every patient receiving treatment for skin and soft tissue infections (SSTIs) must be educated on prevention measures and monitored for efficacy and safety. Efficacy typically is manifested by reductions in temperature, white ...

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