Soft Tissue Infections

(Cellulitis, Abscess, Myositis)

Ardian Riza
Pathogenesis
superficial Impetigo
Non-Bullous: GAS, MSSA, rarely MRSA
Bullous: MSSA with exfoliative toxin, rarely MRSA, purulent
If localized, topical treatment x 5 days unless risk for MRSA
If widespread, oral treatment against MSSA x 7 days unless risk for MRSA
Staphylococcal Scalded Skin Syndrome: IV nafcillin + clindamycin for toxin
Ecthyma
GAS, MSSA, rarely MRSA, use oral treatment against MSSA x 7 days unless risk for MRSA
Ecthyma Gangenosum: immunocomprise or trauma, Pseudomonas, systemically ill
Folliculitis
MSSA, MRSA, rarely Pseudomonas (hot tub), Aeromonas (lake), fungal
Use warm compress or topical treatment
Furuncule/Carbuncle/Abscess
MSSA, MRSA, purulent
Treat with incision and drainage
Adjunctive oral treatment against MSSA if SIRS or incomplete drainage
Empiric treatment against MRSA if colonized, septic, immunocompromised, failed
treatment, or high MRSA prevalence
If recurrent in same location, look for anatomic cause, consider decolonization
If multiple locations, look for immunodeficiency, consider decolonization
deep

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.
superficial Erysipelas, Cellulitis
GAS, MSSA, MRSA
Culture blood if immunocompromised, animal bite, exposure
Use oral treatment against MSSA if uncomplicated
Use systemic treatment if SIRS
Use treatment against MRSA if trauma, colonization, septic
Use broad treatment including gram-negatives if immunocompromised
Hospitalize if SIRS, immunocompromised, poor adherence, failed treatment, or concern for
deep infection
Treat after 4 days post-op if SIRS and wound inflammation with site-dependent regimen
Treat for 5 days, then extend until symptoms resolve
For recurrence, address underlying anatomic causes, consider prophylaxis if 4/year
Necrotizing Fascitis
Type 1 = Mixed anaerobic and facultative (strep, gram-negatives), Type 2 = GAS
Clostridial Myonecrosis: C. perfringens, gas-producing
Prompt surgical consultation if suspected
Workup with MRI if able to be performed quickly or CT and culture of blood and abscess
Use broad IV treatment including anaerobes, add clindamycin for toxin if suspecting GAS
Treat within 2-4 days post-op if SIRS and wound purulence with GAS or Clostridium
If persistently bacteremic, look for residual or metastatic abscess or endocarditis
deep Treat for 3 weeks, can use oral abx if blood clear, no endocarditis, no abscess
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.
Necrotizing Fascitis Contact Dermatitis Cellulitis

Erysipelas Erythema Multiforme Ecthyma

Deep Vein Thrombosis Folliculitis Impetigo

Cellulitis
Treatment
Abscess
Abscess
Abscess
Myositis
Myositis
Myositis
Myositis
Myositis
Terima kasih