Skip to main content

Advertisement

SpringerLink
Log in

Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review

  • Review
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

To review the salient features of the diagnosis and management of the most common skin and soft tissue infections (SSTI). This review focuses on severe SSTIs that require care in an intensive care unit (ICU), including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis.

Methods

Guidelines, expert opinion, and local institutional policies were reviewed.

Results

Severe SSTIs are common and their management complex due to regional variation in predominant pathogens and antimicrobial resistance patterns, as well as variations in host immune responses. Unique aspects of care for SSTIs in the ICU are discussed, including the role of prosthetic devices, risk factors for bacteremia, and the need for surgical consultation. SSTI mimetics, the role of dermatologic consultation, and the unique features of SSTIs in immunocompromised hosts are also described.

Conclusions

We provide recommendations for clinicians regarding optimal SSTI management in the ICU setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hersh AL, Chambers HF, Maselli JH, Gonzales R (2008) National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med 168:1585–1591

    Article  PubMed  Google Scholar 

  2. Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, Spalding J, Jiang J, Oster G (2009) Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis 15:1516–1518

    Article  PubMed  PubMed Central  Google Scholar 

  3. Moet GJ, Jones RN, Biedenbach DJ, Stilwell MG, Fritsche TR (2007) Contemporary causes of skin and soft tissue infections in North America, Latin America, and Europe: report from the SENTRY Antimicrobial Surveillance Program (1998–2004). Diagn Microbiol Infect Dis 57:7–13

    Article  PubMed  Google Scholar 

  4. European Centre for Disease Prevention and Control (2013) Annual Epidemiological Report 2012. Reporting on 2010 surveillance data and 2011 epidemic intelligence data. ECDC, Stockholm

    Google Scholar 

  5. Itani KMF, Sorensen S, Stokes M, Shelbaya A, McKinnon P (2009) A regional comparison of resource utilization in patients with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections (CSSTI) treated with linezolid vs vancomycin. In: [Presentation O-1791] 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), San Francisco

  6. Mullins CD, Yang K, Onukwugha E, Eisenberg DF, Myers DE, Huang DB, Lodise T (2013) Rehospitalizations and direct medical costs for cSSSI: linezolid versus vancomycin. Am J Pharm Benefits 5:258–267

    Google Scholar 

  7. Garau J, Ostermann H, Medina J, Avila M, McBride K, Blasi F (2013) Current management of patients hospitalized with complicated skin and soft tissue infections across Europe (2010–2011): assessment of clinical practice patterns and real-life effectiveness of antibiotics from the REACH study. Clin Microbiol Infect 19:E377–E385

    Article  CAS  PubMed  Google Scholar 

  8. Crisp JG, Takhar SS, Moran GJ, Krishnadasan A, Dowd SE, Finegold SM, Summanen PH, Talan DA (2015) Inability of polymerase chain reaction, pyrosequencing, and culture of infected and uninfected site skin biopsy specimens to identify the cause of cellulitis. Clin Infect Dis 61:1679–1687

    PubMed  Google Scholar 

  9. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC (2014) 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 59:e10–e52

    Article  PubMed  Google Scholar 

  10. Stevens DL (2015) Reply to Gonzalez del Castillo et al and Rashid and Kravitz. Clin Infect Dis 60:172–174

    Article  PubMed  Google Scholar 

  11. Tischendorf J, de Avila RA, Safdar N (2016) Risk of infection following colonization with carbapenem-resistant Enterobactericeae: a systematic review. Am J Infect Control 44:539–543

    Article  PubMed  Google Scholar 

  12. Bolognia JL, Jorizzo J, Schaffer JV (2012) Dermatology. Elsevier Saunders, Philadelphia

    Google Scholar 

  13. Reich HL, Fadeyi DW, Naik NS, Honig PJ, Yan AC (2004) Nonpseudomonal ecthyma gangrenosum. J Am Acad Dermatol 50:S114–S117

    Article  PubMed  Google Scholar 

  14. Vaiman M, Lazarovitch T, Heller L, Lotan G (2015) Ecthyma gangrenosum and ecthyma-like lesions: review article. Eur J Clin Microbiol Infect Dis 34:633–639

    Article  CAS  PubMed  Google Scholar 

  15. Jeng A, Beheshti M, Li J, Nathan R (2010) The role of beta-hemolytic streptococci in causing diffuse, nonculturable cellulitis: a prospective investigation. Medicine 89:217–226

    Article  PubMed  Google Scholar 

  16. Garcia C, Hallin M, Deplano A, Denis O, Sihuincha M, de Groot R, Gotuzzo E, Jacobs J (2013) Staphylococcus aureus causing tropical pyomyositis, Amazon Basin, Peru. Emerg Infect Dis 19:123–125

    Article  PubMed  PubMed Central  Google Scholar 

  17. Theodorou SJ, Theodorou DJ, Resnick D (2007) MR imaging findings of pyogenic bacterial myositis (pyomyositis) in patients with local muscle trauma: illustrative cases. Emerg Radiol 14:89–96

    Article  PubMed  Google Scholar 

  18. Kumar MP, Seif D, Perera P, Mailhot T (2014) Point-of-care ultrasound in diagnosing pyomyositis: a report of three cases. J Emerg Med 47:420–426

    Article  PubMed  Google Scholar 

  19. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H (1991) The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 324:377–384

    Article  CAS  PubMed  Google Scholar 

  20. Mangram AJ, Horan TC, Pearson ML, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278 (quiz 279–280)

    Article  CAS  PubMed  Google Scholar 

  21. Wilson J, Ramboer I, Suetens C (2007) Hospitals in Europe Link for Infection Control through Surveillance (HELICS). Inter-country comparison of rates of surgical site infection–opportunities and limitations. J Hosp Infect 65(Suppl 2):165–170

    Article  PubMed  Google Scholar 

  22. Winfield RD, Reese S, Bochicchio K, Mazuski JE, Bochicchio GV (2016) Obesity and the risk for surgical site infection in abdominal surgery. Am Surg 82:331–336

    PubMed  Google Scholar 

  23. Pedroso-Fernandez Y, Aguirre-Jaime A, Ramos MJ, Hernandez M, Cuervo M, Bravo A, Carrillo A (2016) Prediction of surgical site infection after colorectal surgery. Am J Infect Control 44:450–454

    Article  PubMed  Google Scholar 

  24. Olsen MA, Nickel KB, Margenthaler JA, Fox IK, Ball KE, Mines D, Wallace AE, Colditz GA, Fraser VJ (2016) Development of a risk prediction model to individualize risk factors for surgical site infection after mastectomy. Ann Surg Oncol 23:2471–2479

    Article  PubMed  Google Scholar 

  25. European Centre for Disease Prevention and Control (2013) Surveillance of surgical site infections in Europe 2010–2011. ECDC, Stockholm

    Google Scholar 

  26. Lipsky BA, Kollef MH, Miller LG, Sun X, Johannes RS, Tabak YP (2010) Predicting bacteremia among patients hospitalized for skin and skin-structure infections: derivation and validation of a risk score. Infect Control Hosp Epidemiol 31:828–837

    Article  PubMed  Google Scholar 

  27. Burnham JP, Kollef MH (2015) Understanding toxic shock syndrome. Intensive Care Med 41:1707–1710

    Article  PubMed  Google Scholar 

  28. Cohen AL, Bhatnagar J, Reagan S, Zane SB, D’Angeli MA, Fischer M, Killgore G, Kwan-Gett TS, Blossom DB, Shieh WJ, Guarner J, Jernigan J, Duchin JS, Zaki SR, McDonald LC (2007) Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion. Obstet Gynecol 110:1027–1033

    Article  CAS  PubMed  Google Scholar 

  29. Fischer M, Bhatnagar J, Guarner J, Reagan S, Hacker JK, Van Meter SH, Poukens V, Whiteman DB, Iton A, Cheung M, Dassey DE, Shieh WJ, Zaki SR (2005) Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion. N Engl J Med 353:2352–2360

    Article  CAS  PubMed  Google Scholar 

  30. Stevens DL, Wallace RJ, Hamilton SM, Bryant AE (2006) Successful treatment of staphylococcal toxic shock syndrome with linezolid: a case report and in vitro evaluation of the production of toxic shock syndrome toxin type 1 in the presence of antibiotics. Clin Infect Dis 42:729–730

    Article  PubMed  Google Scholar 

  31. Carapetis JR, Jacoby P, Carville K, Ang SJ, Curtis N, Andrews R (2014) Effectiveness of clindamycin and intravenous immunoglobulin, and risk of disease in contacts, in invasive group a streptococcal infections. Clin Infect Dis 59:358–365

    Article  CAS  PubMed  Google Scholar 

  32. Stevens DL, Ma Y, Salmi DB, McIndoo E, Wallace RJ, Bryant AE (2007) Impact of antibiotics on expression of virulence-associated exotoxin genes in methicillin-sensitive and methicillin-resistant Staphylococcus aureus. J Infect Dis 195:202–211

    Article  CAS  PubMed  Google Scholar 

  33. Coyle EA, Cha R, Rybak MJ (2003) Influences of linezolid, penicillin, and clindamycin, alone and in combination, on streptococcal pyrogenic exotoxin a release. Antimicrob Agents Chemother 47:1752–1755

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Darenberg J, Ihendyane N, Sjolin J, Aufwerber E, Haidl S, Follin P, Andersson J, Norrby-Teglund A (2003) Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial. Clin Infect Dis 37:333–340

    Article  CAS  PubMed  Google Scholar 

  35. Linner A, Darenberg J, Sjolin J, Henriques-Normark B, Norrby-Teglund A (2014) Clinical efficacy of polyspecific intravenous immunoglobulin therapy in patients with streptococcal toxic shock syndrome: a comparative observational study. Clin Infect Dis 59:851–857

    Article  CAS  PubMed  Google Scholar 

  36. Matsushima A, Kuroki Y, Nakajima S, Sakai T, Kojima H, Ueyama M (2015) Low level of TSST-1 antibody in burn patients with toxic shock syndrome caused by methicillin-resistant Staphylococcus aureus. J Burn Care Res 36:e120–e124

    Article  PubMed  Google Scholar 

  37. Umbert IJ, Winkelmann RK, Oliver GF, Peters MS (1989) Necrotizing fasciitis: a clinical, microbiologic, and histopathologic study of 14 patients. J Am Acad Dermatol 20:774–781

    Article  CAS  PubMed  Google Scholar 

  38. Bangsberg DR, Rosen JI, Aragon T, Campbell A, Weir L, Perdreau-Remington F (2002) Clostridial myonecrosis cluster among injection drug users: a molecular epidemiology investigation. Arch Intern Med 162:517–522

    Article  PubMed  Google Scholar 

  39. Ahmed S, Gruer L, McGuigan C, Penrice G, Roberts K, Hood J, Redding P, Edwards G, Black M, McFarlane J, Cromie D, Howie H, Leonard A, Goldberg D, Taylor A, Hutchinson S, Roy K, Wadd S, Andraghetti R, Barry J, Sayers G, Cronin M, O'Connell T, Ward M, O'Sullivan P, O'Herlihy B, Keenan E, O'Connor J, Mullen L, Sweeney B, O'Flanagan D, Igoe D, Bergin C, O'Briain S, Keane C, Mulvihill E, Plunkett P, McMahon G, Boyle T, Clarke S, Leen E, Cassidy M, Djuretic T, Gill N, Hope V, Jones J, Nichols G, Weild A, George R, Borriello P, Brazier J, Salmon J, Lightfoot N, Roberts A (2000) Update: Clostridium novyi and unexplained illness among injecting-drug users-Scotland, Ireland, and England, April–June 2000. MMWR Morb Mortal Wkly Rep 49:543–545

    Google Scholar 

  40. Kimura AC, Higa JI, Levin RM, Simpson G, Vargas Y, Vugia DJ (2004) Outbreak of necrotizing fasciitis due to Clostridium sordellii among black-tar heroin users. Clin Infect Dis 38:e87–e91

    Article  PubMed  Google Scholar 

  41. Aldape MJ, Bryant AE, Stevens DL (2006) Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment. Clin Infect Dis 43:1436–1446

    Article  CAS  PubMed  Google Scholar 

  42. Sinave C, Le Templier G, Blouin D, Leveille F, Deland E (2002) Toxic shock syndrome due to Clostridium sordellii: a dramatic postpartum and postabortion disease. Clin Infect Dis 35:1441–1443

    Article  PubMed  Google Scholar 

  43. Ellis Simonsen SM, van Orman ER, Hatch BE, Jones SS, Gren LH, Hegmann KT, Lyon JL (2006) Cellulitis incidence in a defined population. Epidemiol Infect 134:293–299

    Article  CAS  PubMed  Google Scholar 

  44. Das DK, Baker MG, Venugopal K (2011) Increasing incidence of necrotizing fasciitis in New Zealand: a nationwide study over the period 1990–2006. J Infect 63:429–433

    Article  PubMed  Google Scholar 

  45. Shaked H, Samra Z, Paul M, Madar-Shapiro L, Cohen J, Pitlik S, Bishara J (2012) Unusual “flesh-eating” strains of Escherichia coli. J Clin Microbiol 50:4008–4011

    Article  PubMed  PubMed Central  Google Scholar 

  46. Cheng NC, Yu YC, Tai HC, Hsueh PR, Chang SC, Lai SY, Yi WC, Fang CT (2012) Recent trend of necrotizing fasciitis in Taiwan: focus on monomicrobial Klebsiella pneumoniae necrotizing fasciitis. Clin Infect Dis 55:930–939

    Article  PubMed  Google Scholar 

  47. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO (2003) Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 85-a:1454–1460

    Article  PubMed  Google Scholar 

  48. Kim KT, Kim YJ, Won Lee J, Kim YJ, Park SW, Lim MK, Suh CH (2011) Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology 259:816–824

    Article  PubMed  Google Scholar 

  49. El-Gazzaz GH, Farag SH, El-Sayd MA, Mohamed HH (2012) The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: risk of infection and recurrence. Asian J Surg 35:149–153

    Article  PubMed  Google Scholar 

  50. Nienaber JJ, Kusne S, Riaz T, Walker RC, Baddour LM, Wright AJ, Park SJ, Vikram HR, Keating MR, Arabia FA, Lahr BD, Sohail MR (2013) Clinical manifestations and management of left ventricular assist device-associated infections. Clin Infect Dis 57:1438–1448

    Article  PubMed  PubMed Central  Google Scholar 

  51. Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, Bolger AF, Estes NA 3rd, Gewitz M, Newburger JW, Schron EB, Taubert KA (2010) Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation 121:458–477

    Article  PubMed  Google Scholar 

  52. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 49:1–45

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Strazzula L, Cotliar J, Fox LP, Hughey L, Shinkai K, Gee SN, Kroshinsky D (2015) Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: a multi-institutional analysis. J Am Acad Dermatol 73:70–75

    Article  PubMed  Google Scholar 

  54. Arakaki RY, Strazzula L, Woo E, Kroshinsky D (2014) The impact of dermatology consultation on diagnostic accuracy and antibiotic use among patients with suspected cellulitis seen at outpatient internal medicine offices: a randomized clinical trial. JAMA Dermatol 150:1056–1061

    Article  PubMed  Google Scholar 

  55. Falagas ME, Vergidis PI (2005) Narrative review: diseases that masquerade as infectious cellulitis. Ann Intern Med 142:47–55

    Article  PubMed  Google Scholar 

  56. Agrawal P, Peter JV, George R (2013) Dermatological manifestations and relationship to outcomes of patients admitted to a medical intensive care unit: a study from a tertiary care hospital in India. Postgrad Med J 89:501–507

    Article  PubMed  Google Scholar 

  57. George SM, Harrison DA, Welch CA, Nolan KM, Friedmann PS (2008) Dermatological conditions in intensive care: a secondary analysis of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database. Crit Care 12(Suppl 1):S1

    Article  PubMed  PubMed Central  Google Scholar 

  58. Emre S, Emre C, Akoglu G, Demirseren DD, Metin A (2013) Evaluation of dermatological consultations of patients treated in intensive care unit. Dermatology 226:75–80

    Article  PubMed  Google Scholar 

  59. Badia M, Servia L, Casanova JM, Montserrat N, Vilanova J, Vicario E, Rodriguez A, Trujillano J (2013) Classification of dermatological disorders in critical care patients: a prospective observational study. J Crit Care 28:220 (e221–228)

    Article  PubMed  Google Scholar 

  60. de Prost N, Sbidian E, Chosidow O, Brun-Buisson C, Amathieu R (2015) Management of necrotizing soft tissue infections in the intensive care unit: results of an international survey. Intensive Care Med 41:1506–1508

    Article  PubMed  Google Scholar 

  61. de Geus HR, van der Klooster JM (2005) Vacuum-assisted closure in the treatment of large skin defects due to necrotizing fasciitis. Intensive Care Med 31:601

    Article  PubMed  Google Scholar 

  62. Chen IW, Yang HM, Chiu CH, Yeh JT, Huang CH, Huang YY (2015) Clinical characteristics and risk factor analysis for lower-extremity amputations in diabetic patients with foot ulcer complicated by necrotizing fasciitis. Medicine 94:e1957

    Article  PubMed  PubMed Central  Google Scholar 

  63. Pham TN, Moore ML, Costa BA, Cuschieri J, Klein MB (2009) Assessment of functional limitation after necrotizing soft tissue infection. J Burn Care Res 30:301–306

    Article  PubMed  PubMed Central  Google Scholar 

  64. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801–810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. European Centre for Disease Prevention and Control (2016) Proportion of methicillin resistant Staphylococcus aureus (MRSA) isolates in participating countries in 2014. ECDC, Stockholm. Accessed 19 July 2016

    Google Scholar 

  66. Zilberberg M, Micek ST, Kollef MH, Shelbaya A, Shorr AF (2012) Risk factors for mixed complicated skin and skin structure infections to help tailor appropriate empiric therapy. Surg Infect 13:377–382

    Article  Google Scholar 

  67. Eells SJ, Nguyen M, Jung J, Macias-Gil R, May L, Miller LG (2016) Relationship between adherence to oral antibiotics and postdischarge clinical outcomes among patients hospitalized with staphylococcus aureus skin infections. Antimicrob Agents Chemother 60:2941–2948

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Casabar E, Portell J The tool book: drug dosing and treatment guidelines. Barnes-Jewish Hospital, Department of Pharmacy, St. Louis. https://www.dorsata.com/client#. Accessed 19 May 2016

  69. Canut A, Isla A, Rodriguez-Gascon A (2015) Pharmacokinetic/pharmacodynamic analysis to evaluate ceftaroline fosamil dosing regimens for the treatment of community-acquired bacterial pneumonia and complicated skin and skin-structure infections in patients with normal and impaired renal function. Int J Antimicrob Agents 45:399–405

    Article  CAS  PubMed  Google Scholar 

  70. Furtek KJ, Kubiak DW, Barra M, Varughese CA, Ashbaugh CD, Koo S (2016) High incidence of neutropenia in patients with prolonged ceftaroline exposure. J Antimicrob Chemother 71:2010–2013

    Article  CAS  PubMed  Google Scholar 

  71. Patel N, Cardone K, Grabe DW, Meola S, Hoy C, Manley H, Drusano GL, Lodise TP (2011) Use of pharmacokinetic and pharmacodynamic principles to determine optimal administration of daptomycin in patients receiving standardized thrice-weekly hemodialysis. Antimicrob Agents Chemother 55:1677–1683

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Burnham JP, Burnham CA, Warren DK, Kollef MH (2016) Impact of time to appropriate therapy on mortality in patients with vancomycin intermediate Staphylococcus aureus infection. Antimicrob Agents Chemother 60:5546–5553

    Article  PubMed  Google Scholar 

  73. Flanagan S, Bartizal K, Minassian SL, Fang E, Prokocimer P (2013) In vitro, in vivo, and clinical studies of tedizolid to assess the potential for peripheral or central monoamine oxidase interactions. Antimicrob Agents Chemother 57:3060–3066

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Panackal AA, Hajjeh RA, Cetron MS, Warnock DW (2002) Fungal infections among returning travelers. Clin Infect Dis 35:1088–1095

    Article  PubMed  Google Scholar 

  75. Uys A, Rapoport BL, Anderson R (2004) Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk-index score. Support Care Cancer 12:555–560

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA

    Jason P. Burnham

  2. Division of General Surgery, Acute and Critical Care Surgery Section, Washington University School of Medicine, St. Louis, MO, USA

    John P. Kirby

  3. Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Ave, Campus Box 8052, St. Louis, MO, 63110, USA

    Marin H. Kollef

Authors
  1. Jason P. Burnham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John P. Kirby
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marin H. Kollef
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marin H. Kollef.

Ethics declarations

Conflicts of interest

Dr. J.P. Burnham has no conflicts of interest to report. Dr. J.P. Kirby has no conflicts of interest to report. Dr. Kollef was supported by the Barnes-Jewish Hospital Foundation.

Additional information

Work was performed at Barnes-Jewish Hospital, St. Louis, MO.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burnham, J.P., Kirby, J.P. & Kollef, M.H. Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review. Intensive Care Med 42, 1899–1911 (2016). https://doi.org/10.1007/s00134-016-4576-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-016-4576-0

Keywords

Search

Navigation