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Emergency Department Management of Acute Bacterial Skin and Soft Tissue Infections

  • Infectious Disease (J Glauser, Section Editor)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Acute skin infections are a common Emergency Department presentation. Changes in microbial resistance to antibiotics have resulted in changes in management of these infections. This paper seeks to highlight these changes in management of cellulitis and abscesses with the new emergence of methicillin-resistant Staphylococcal aureus.

Recent Findings

Soft tissue infections are most commonly caused by Streptococcus and Staphylococcus but other microbes are present in specific environments and can cause infections when patients are exposed. Simple cellulitis can be treated with beta lactams; however, purulent infections are more likely to be resistant and antibiotic choices should reflect this. Recently, novel antibiotics with extended half-lives have been created that allow for soft tissue infection treatments to be given in a single dose. These antibiotics could be useful in patients with soft tissue infection who are at risk for beta lactam resistance and will be topic of further research.

Summary

As resistance to antibiotics increases clinicians must but aware of these changes to best care for patients with skin and soft tissue infections.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • May L, Klein EY, Martinez EM, Mojica N, Miller LG. Incidence and factors associated with emergency department visits for recurrent skin and soft tissue infections in patients in California, 2005-2011. Epidemiol Infect. 2017;145:746–54. Good overview of the rates of infection

    Article  CAS  Google Scholar 

  2. Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, et al. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis. 2009;15:1516–8.

    Article  Google Scholar 

  3. Ellis Simonsen SM, van Orman ER, Hatch BE, Jones SS, Gren LH, Hegmann KT, et al. Cellulitis incidence in a defined population. Epidemiol Infect. 2006;134:293–9.

    Article  CAS  Google Scholar 

  4. Kessler DO, Krantz A, Mojica M. Randomized trial comparing wound packing to no wound packing following incision and drainage of superficial skin abscesses in the pediatric emergency department. Pediatr Emerg Care. 2012;28:514–7.

    Article  Google Scholar 

  5. Tsoraides SS, Pearl RH, Stanfill AB, Wallace LJ, Vegunta RK. Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children. J Pediatr Surg. 2010;45:606–9.

    Article  Google Scholar 

  6. Pickett A, Wilkinson M, Menoch M, Snell J, Yniguez R, Bulloch B. Changing incidence of methicillin-resistant Staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009;25:831–4.

    Article  Google Scholar 

  7. Moran GJ, Amii RN, Abrahamian FM, Talan DA. Methicillin-resistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis. 2005;11:928–30.

    Article  Google Scholar 

  8. • Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Infectious Diseases Society of, 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;59:e10–52. Most rescent update from IDSA

    Article  Google Scholar 

  9. Jenkins TC, Knepper BC, Jason Moore S, Saveli CC, Pawlowski SW, Perlman DM, et al. Microbiology and initial antibiotic therapy for injection drug users and non-injection drug users with cutaneous abscesses in the era of community-associated methicillin-resistant Staphylococcus aureus. Acad Emerg Med. 2015;22:993–7.

    Article  Google Scholar 

  10. Lodise TP, Redell M, Armstrong SO, Sulham KA, Corey GR. Efficacy and safety of oritavancin relative to vancomycin for patients with acute bacterial skin and skin structure infections (ABSSSI) in the outpatient setting: results from the solo clinical trials. Open Forum Infect Dis. 2017;4:ofw274.

    Article  Google Scholar 

  11. • Jensen IS, Lodise TP, Fan W, Wu C, Cyr PL, Nicolau DP, et al. Use of oritavancin in acute bacterial skin and skin structure infections patients receiving intravenous antibiotics: a US hospital budget impact analysis. Clin Drug Inv. 2016;36:157–68. Intreseting analysis of the economics of the use of long acting antibiotics

    Article  CAS  Google Scholar 

  12. Bowen AC, Mahe A, Hay RJ, Andrews RM, Steer AC, Tong SY, et al. The global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PLoS One. 2015;10:e0136789.

    Article  Google Scholar 

  13. Pereira LB. Impetigo - review. An Bras Dermatol. 2014;89:293–9.

    Article  Google Scholar 

  14. Stevens DL, Bryant AE. Impetigo, erysipelas and cellulitis, In: J.J. Ferretti, D.L. Stevens, V.A. Fischetti (Eds.) Streptococcus pyogenes: basic biology to clinical manifestations, Oklahoma City (OK), 2016.

  15. Nweze N, Parsikia A, Ahuja R, Joshi ART. Axillary hidradenitis: risk factors for recurrence after surgical excision in 214 patients. Am Surg. 2018;84:422–7.

    PubMed  Google Scholar 

  16. Saunte DML, Jemec GBE. Hidradenitis suppurativa: advances in diagnosis and treatment. JAMA. 2017;318:2019–32.

    Article  Google Scholar 

  17. Robert E, Bodin F, Paul C, Konstantinou MP, Gall Y, Grolleau JL, et al. Non-surgical treatments for hidradenitis suppurativa: a systematic review. Ann Chir Plast Esthet. 2017;62:274–94.

    Article  CAS  Google Scholar 

  18. Bhide A, Nama V, Patel S, Kalu E. Microbiology of cysts/abscesses of Bartholin’s gland: review of empirical antibiotic therapy against microbial culture. J Obstet Gynaecol. 2010;30:701–3.

    Article  CAS  Google Scholar 

  19. Brook I. Aerobic and anaerobic microbiology of Bartholin’s abscess. Surg Gynecol Obstet. 1989;169:32–4.

    CAS  PubMed  Google Scholar 

  20. Surrell JA. Pilonidal disease. Surg Clin North Am. 1994;74:1309–15.

    Article  CAS  Google Scholar 

  21. Brook I. Microbiology of infected pilonidal sinuses. J Clin Pathol. 1989;42:1140–2.

    Article  CAS  Google Scholar 

  22. Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, et al. Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep. 2018;8:3058.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Jon W. Schrock

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  1. Jon W. Schrock
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Correspondence to Jon W. Schrock.

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The author declares that there is no conflict of interest.

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

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This article is part of the Topical Collection on Infectious Disease.

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Schrock, J.W. Emergency Department Management of Acute Bacterial Skin and Soft Tissue Infections. Curr Emerg Hosp Med Rep 6, 162–165 (2018). https://doi.org/10.1007/s40138-018-0172-7

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  • DOI: https://doi.org/10.1007/s40138-018-0172-7

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