Current Infectious Disease Reports

, Volume 8, Issue 5, pp 384–389

Optimal management of uncomplicated skin and skin structure infections of the lower extremity

Article

Abstract

Uncomplicated skin and skin structure infections of the lower extremity are almost always curable when properly diagnosed and promptly treated with antibiotics, but they can cause serious complications if not treated appropriately. These infections are caused often by Staphylococcus aureus and less commonly by Streptococcus pyogenes. Initial treatment is usually empiric. Although the most suitable oral treatment is likely cephalosporin, other options include β-lactamase inhibitor-penicillin combinations and penicillinase-resistant penicillins. In some cases, incision and drainage or debridement may be required.

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References and Recommended Reading

  1. 1.
    Lipsky B: Infectious problems of the foot in diabetic patients. In The Diabetic Foot, Sixth Edition. Edited by Bowker JH and Pfeifer MA. St. Louis: Mosby; 2001:467–480.Google Scholar
  2. 2.
    Lipsky BA: Osteomyelitis of the foot in diabetic patients. Clin Infect Dis 1997, 25:1318–1326.PubMedGoogle Scholar
  3. 3.
    Smith DM, Weinberger M, Katz BP: Predicting nonelective hospitalization: a model based on risk factors associated with diabetes mellitus. J Gen Intern Med 1987, 2:168–173.PubMedCrossRefGoogle Scholar
  4. 4.
    Currie CJ, Morgan CL, Peters JR: The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy, and ulceration in diabetes. Diabetes Care 1998, 21:42–48.PubMedCrossRefGoogle Scholar
  5. 5.
    Reiber G: Epidemiology of foot ulcers and amputations in the diabetic foot. In The Diabetic Foot, Sixth Edition. Edited by Bowker JH and Pfeifer MA. St. Louis: Mosby; 2001:13–32.Google Scholar
  6. 6.
    Lipsky BA, Berendt AR, Deery HG, et al.: Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004, 39:885–910. Evidenced-based consensus statement from the Infectious Diseases Society of America. One of the most thorough documents ever written on the topic.PubMedCrossRefGoogle Scholar
  7. 7.
    Caputo GM, Cavanagh PR, Ulbrecht JS, et al.: Assessment and management of foot disease in patients with diabetes. N Engl J Med 1994, 331:854–860.PubMedCrossRefGoogle Scholar
  8. 8.
    Frykberg RG. Diabetic foot ulcers: current concepts. J Foot Ankle Surg 1998, 37:440 -446.PubMedGoogle Scholar
  9. 9.
    Joshi N, Caputo GM, Weitekamp MR, Karchmer AW: Infections in patients with diabetes mellitus. N Engl J Med 1999, 341:1906–1912.PubMedCrossRefGoogle Scholar
  10. 10.
    Lipsky BA, Itani K, Norden C: Treating foot infections in diabetic patients: a randomized, multicenter, open-label trial of linezolid versus ampicillin-sulbactam/amoxicillinclavulanate. Clin Infect Dis 2004, 38:17–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Cox NH: Management of lower leg cellulitis. Clin Med 2002, 2:23–27.PubMedGoogle Scholar
  12. 12.
    Baddour LM: Recent considerations in recurrent cellulitis. Curr Infect Dis Rep 2001, 3:461–465.PubMedGoogle Scholar
  13. 13.
    O’Dell ML: Skin and wound infections: an overview. Am Fam Physician 1998, 57:2424 -2432.PubMedGoogle Scholar
  14. 14.
    Stalbow J: Preventing cellulitis in older people with persistent lower limb oedema. Br J Nurs 2004, 13:725–732.PubMedGoogle Scholar
  15. 15.
    Ginsberg MB: Cellulitis: analysis of 101 cases and review of the literature. South Med J 1981, 74:530–533.PubMedGoogle Scholar
  16. 16.
    Karakas M, Baba M, Aksungur VL, et al.: Manifestation of cellulitis after saphenous venectomy for coronary bypass surgery. J Eur Acad Dermatol Venereol 2002, 16:438–440.PubMedCrossRefGoogle Scholar
  17. 17.
    Baddour LM, Bisno AL: Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med 1985, 79:155–159.PubMedCrossRefGoogle Scholar
  18. 18.
    Hurwitz RM, Tisserand ME: Streptococcal cellulitis proved by skin biopsy in a coronary artery bypass graft patient. Arch Dermatol 1985, 121:908–909.PubMedCrossRefGoogle Scholar
  19. 19.
    Jego P, Resche S, Karacatsanis C, et al.: Erysipelas. A retrospective series of 92 patients in a department of internal medicine [in French]. Ann Med Interne (Paris) 2000, 151:3–9.Google Scholar
  20. 20.
    Joseph WS, Zgonis T, Roukis TS: A closer look at diabetic foot infections. Podiatry Today 2005, 18:56–66.Google Scholar
  21. 21.
    Murakawa GJ: Common pathogens and differential diagnosis of skin and soft tissue infections. Cutis 2004, 73(Suppl 5):7–10.PubMedGoogle Scholar
  22. 22.
    U.S Food and Drug Administration: Guidance for Industry. uncomplicated and complicated skin and skin structure infections—developing antimicrobial drugs for treatment. Draft guidance. http://www.fda.gov/cder/guidance/ 2566dft.pdf. Accessed August 24, 2005.Google Scholar
  23. 23.
    Lipsky BA, Pecoraro RE, Wheat LJ: The diabetic foot. Soft tissue and bone infection. Infect Dis Clin North Am 1990, 4:409–432.PubMedGoogle Scholar
  24. 24.
    Joseph WS, Axler DA: Microbiology and antimicrobial therapy of diabetic foot infections. Clin Podiatr Med Surg 1990, 7:467–481.PubMedGoogle Scholar
  25. 25.
    Grayson ML: Diabetic foot infections. Antimicrobial therapy. Infect Dis Clin North Am 1995, 9:143–161.PubMedGoogle Scholar
  26. 26.
    Goldstein EJ, Citron DM, Nesbit CA: Diabetic foot infections. Bacteriology and activity of 10 oral antimicrobial agents against bacteria isolated from consecutive cases. Diabetes Care 1996, 19:638–641.PubMedCrossRefGoogle Scholar
  27. 27.
    Urbancic-Rovan V, Gubina M: Bacteria in superficial diabetic foot ulcers. Diabet Med 2000, 17:814–815.PubMedCrossRefGoogle Scholar
  28. 28.
    Bernard P, Bedane C, Mounier M, et al.: Streptococcal cause of erysipelas and cellulitis in adults. A microbiologic study using a direct immunofluorescence technique. Arch Dermatol 1989, 125:779–82.PubMedCrossRefGoogle Scholar
  29. 29.
    Semel JD, Goldin H: Association of athlete’s foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples. Clin Infect Dis 1996, 23:1162–1164.PubMedGoogle Scholar
  30. 30.
    Hugo-Persson M, Norlin K: Erysipelas and group G streptococci. Infection 1987, 15:184–187.PubMedCrossRefGoogle Scholar
  31. 31.
    Maranan MC, Moreira B, Boyle-Vavra S, Daum RS: Antimicrobial resistance in staphylococci. Epidemiology, molecular mechanisms, and clinical relevance. Infect Dis Clin North Am 1997, 11:813–849.PubMedCrossRefGoogle Scholar
  32. 32.
    Fluckiger U, Widmer AF: Epidemiology of methicillinresistant Staphylococcus aureus. Chemotherapy 1999, 45:121–134.PubMedCrossRefGoogle Scholar
  33. 33.
    Dang CN, Prasad YD, Boulton AJ, Jude EB: Methicillinresistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med 2003, 20:159–161. A study that shows the increasing incidence of MRSA in the diabetic foot wound. Shows that the MRSA was eradicated without specific anti-MRSA therapy.PubMedCrossRefGoogle Scholar
  34. 34.
    Mantey I, Hill RL, Foster AV, et al.: Infection of foot ulcers with Staphylococcus aureus associated with increased mortality in diabetic patients. Commun Dis Public Health 2000, 3:288–290.PubMedGoogle Scholar
  35. 35.
    Wagner A, Reike H, Angelkort B: Highly resistant pathogens in patients with diabetic foot syndrome with special reference to methicillin-resistant Staphylococcus aureus infections [in German]. Dtsch Med Wochenschr 2001, 126:1353–1356.PubMedCrossRefGoogle Scholar
  36. 36.
    Tentolouris N, Jude EB, Smirnof I, et al.: Methicillinresistant Staphylococcus aureus: an increasing problem in a diabetic foot clinic. Diabet Med 1999, 16:767–771.PubMedCrossRefGoogle Scholar
  37. 37.
    International Working Group on the Diabetic Foot: International consensus on the diabetic foot [CD-ROM]. Brussels: International Diabetes Foundation; 2003.Google Scholar
  38. 38.
    Fridkin SK, Hageman JC, Morrison M, et al.: Methicillinresistant Staphylococcus aureus disease in three communities. N Engl J Med 2005, 352:1436–1444. An interesting discussion of the increasing prevalence of communityacquired MRSA. The study showed that patients not treated specifically for CA-MRSA did not suffer any adverse outcomes.PubMedCrossRefGoogle Scholar
  39. 39.
    Lipsky BA, Pecoraro RE, Larson SA, et al.: Outpatient management of uncomplicated lower-extremity infections in diabetic patients. Arch Intern Med 1990, 150:790–797.PubMedCrossRefGoogle Scholar
  40. 40.
    Peterson LR, Lissack LM, Canter K, et al.: Therapy of lower extremity infections with ciprofloxacin in patients with diabetes mellitus, peripheral vascular disease, or both. Am J Med 1989, 86:801–808.PubMedCrossRefGoogle Scholar
  41. 41.
    Sesin GP, Paszko A, O’Keefe E: Oral clindamycin and ciprofloxacin therapy for diabetic foot infections. Pharmacotherapy 1990, 10:154 -156.PubMedGoogle Scholar
  42. 42.
    Scher RK, Elston DM, Hedrick JA, et al.: Treatment options in the management of uncomplicated skin and skin structure infections. Cutis 2005, 75(Suppl 1):3–23.PubMedGoogle Scholar
  43. 43.
    Pichichero ME: A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics 2005, 115:1048–1057.PubMedCrossRefGoogle Scholar
  44. 44.
    American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media: Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics 2004, 113:1451–1466.Google Scholar
  45. 45.
    American Academy of Pediatrics Subcommittee on Management of Sinusitis and Committee on Quality Improvement: Clinical practice guideline: management of sinusitis. Pediatrics 2001, 108:798–808.Google Scholar
  46. 46.
    Todd PA, Benfield P: Amoxicillin/clavulanic acid. An update of its antibacterial activity, pharmacokinetic properties and therapeutic use. Drugs 1990, 39:264–307.PubMedCrossRefGoogle Scholar
  47. 47.
    Gentry LO: Therapy with newer oral beta-lactam and quinolone agents for infections of the skin and skin structures: a review. Clin Infect Dis 1992, 14:285–297.PubMedGoogle Scholar
  48. 48.
    Wilson SE: The management of skin and skin structure infections in children, adolescents and adults: a review of empiric antimicrobial therapy. Int J Clin Pract 1998, 52:414–417.PubMedGoogle Scholar
  49. 49.
    Fung-Tomc JC, Huczko E, Stickle T, et al.: Antibacterial activities of cefprozil compared with those of 13 oral cephems and 3 macrolides. Antimicrob Agents Chemother 1995 39(2):533–8.PubMedGoogle Scholar
  50. 50.
    Sader HS, Streit JM, Fritsche TR, Jones RN: Potency and spectrum reevaluation of cefdinir tested against pathogens causing skin and soft tissue infections: a sample of North American isolates. Diagn Microbiol Infect Dis 2004, 49:283–287.PubMedCrossRefGoogle Scholar
  51. 51.
    Tack KJ, Littlejohn TW, Mailloux G, et al.: Cefdinir versus cephalexin for the treatment of skin and skin-structure infections. The Cefdinir Adult Skin Infection Study Group. Clin Ther 1998, 20:244–256.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.Huntingdon ValleyUSA

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