Update on Management of Skin and Soft Tissue Infections in the Emergency Department

  • Michael S. Pulia
  • Mary R. Calderone
  • John R. Meister
  • Jamie Santistevan
  • Larissa May
Skin, Soft Tissue, Bone and Joint Infectious Diseases (N Safdar, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Skin, Soft Tissue, Bone and Joint Infections

Abstract

Skin and soft tissue infections (SSTIs) are frequently treated in the emergency department (ED) setting. Recent studies provide critical new information that can guide new approaches to the diagnosis and treatment of SSTIs in the ED. Rapid polymerase chain reaction assays capable of detecting MRSA in approximately 1 h hold significant potential to improving antibiotic stewardship in SSTI care. Emergency ultrasound continues to demonstrate value in guiding appropriate management of SSTIs, including the early diagnosis of necrotizing infections. Since emerging in the 1990s, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) continues to increase in prevalence, and it represents a significant challenge to optimizing ED antibiotic use for SSTI management. Growing literature reinforces the current recommendation of incision and drainage without antibiotics for uncomplicated abscesses. Selecting antibiotics with CA-MRSA coverage is recommended when treating purulent SSTIs; however, it is generally not necessary in cases of nonpurulent cellulitis. Future advances in ED SSTI care may involve expansion of outpatient parenteral antimicrobial therapy protocols and the recent development of a novel, once weekly antibiotic with activity against MRSA.

Keywords

Abscess Cellulitis Skin and soft tissue infection CA-MRSA Antimicrobial Infection Antibiotic stewardship PCR Necrotizing fasciitis Blood cultures Emergency ultrasound Incision and drainage ABSSSI Home infusion therapy 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Mary Calderone, Jamie Santistevan and John Meister declare no conflicts of interest. Larissa May has served as a consultant for Durata Therapeutics and has received payment for educational presentation from Cepheid and research support from Cepheid. Michael Pulia received payment for educational presentations and research support from Cepheid.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Michael S. Pulia
    • 1
  • Mary R. Calderone
    • 2
  • John R. Meister
    • 1
  • Jamie Santistevan
    • 1
  • Larissa May
    • 3
  1. 1.Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of Emergency MedicineUniversity of MichiganAnn ArborUSA
  3. 3.Department of Emergency Medicine and Medicine-Section of Infectious DiseaseThe George Washington University School of MedicineWashingtonUSA

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