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  • Print publication year: 2008
  • Online publication date: December 2009

43 - Bacterial Skin and Soft-Tissue Infections

from Part I - Systems
    • By Teri A. Reynolds, Associate Editor, Alameda County Medical Center–Highland Campus, Oakland, CA, Bradley W. Frazee, Associate Clinical Professor of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, Alameda County Medical Center–Highland Campus, Oakland, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Publisher: Cambridge University Press
  • https://doi.org/10.1017/CBO9780511547454.044
  • pp 257-262
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Summary

INTRODUCTION

Skin and soft-tissue infections, comprising abscess, cellulitis, and necrotizing soft-tissue infection (NSTI), account for 1.8 million annual emergency department (ED) visits in the United States alone (Table 43.1). There has been a recent dramatic shift in bacteriology, with a rise in the prevalence of staphylococcal infection and of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), requiring new empiric antibiotic strategies. Emergency physicians are often in a position to make the first diagnosis and treatment of skin and soft-tissue infections. In the case of potentially lethal NSTI, highly time-dependent morbidity and mortality require familiarity with diverse presentations and the limitations of diagnostic tests.

EPIDEMIOLOGY

Abscess

Risk factors for abscess formation include injection drug use (IDU), shaving, and known colonization or infection with CA-MRSA. Staphylococcus aureus is implicated in 19–71% of abscess cases. It is highly prevalent, colonizing approximately 30% of the general population and an even higher proportion of injection drug users, diabetics, and health care workers. The rising prevalence of CA-MRSA in the United States has manifested largely as a rise in spontaneous skin and soft-tissue infections. Nearly all S. aureus strains secrete exotoxins (including hemolysins, nucleases, proteases, lipases, hyaluronidase, and collagenase) that convert host tissues into nutrients required for bacterial growth. Additionally, some methicillin-sensitive S. aureus (MSSA) and the majority of CA-MRSA strains carry genes for Panton-Valentine leukocidin (PVL), a cytotoxin causing leukocyte destruction, tissue necrosis, and enhanced abscess formation.

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Emergency Management of Infectious Diseases
  • Online ISBN: 9780511547454
  • Book DOI: https://doi.org/10.1017/CBO9780511547454
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REFERENCES
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Kaul, R, McGeer, A, Low, D E, et al. Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med 1997 Jul;103(1):18–24.
Meislin, H W, Lerner, S A, Graves, M H, et al. Cutaneous abscesses. Anaerobic and aerobic bacteriology and outpatient management. Ann Intern Med 1977 Aug;87(2):145–9.
Moran, G J, Krishnadasan, A, Gorwitz, R J, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–7.
Perl, B, Gottehrer, N P, Raveh, D, et al. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis 1999 Dec;29(6):1483–8.
Rutherford, W H, Hart, D, Calderwood, J W, Merrett, J D. Antibiotics in surgical treatment of septic lesions. Lancet 1970 May 23;1(7656):1077–80.
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ADDITIONAL READINGS
Stevens, D L, Bisno, A L, Chambers, H F, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections (IDSA Guidelines). Clin Infect Dis 2005;41:1373–1406.
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