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Surgical Management: Acute Soft Tissue and Bone Infections

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Abstract

Skin and soft tissue infections (SSTIs), acute bacterial skin and skin structure infections (ABSSSI), and bone infections (osteomyelitis) may complicate acute management of orthopedic injuries. SSTIs range from superficial surgical site infection after fracture repair to severe infections, including necrotizing soft tissue infections and acute/chronic osteomyelitis. Fracture-related infection (FRI) is a severe complication after bony trauma, and a recent consensus definition was developed to standardize diagnostic criteria and promote optimal patient care. Knowledge of common causative bacterial pathogens and appropriate antimicrobial therapy is necessary in the care of these patients. MRSA has emerged as the most common identifiable cause of severe SSTIs; therefore, initiation of empiric anti-MRSA antimicrobials is warranted in all cases of severe SSTIs and osteomyelitis. There are four fundamental management principles that are key to a successful outcome in caring for patients with severe SSTIs, including (1) early diagnosis and differentiation of necrotizing vs. non-necrotizing SSTI, (2) early initiation of appropriate empiric broad-spectrum antimicrobial therapy with consideration of risk factors for specific pathogens, (3) “source control,” i.e., early aggressive surgical intervention for drainage of abscesses and debridement of necrotizing soft tissue infections, and (4) pathogen identification and appropriate de-escalation of antimicrobial therapy.

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References

  1. Napolitano LM. The diagnosis and treatment of skin and soft tissue infections (SSTIs). Surg Infect. 2008;9(Suppl 1):1.

    Article  Google Scholar 

  2. Napolitano LM. Severe soft tissue infections. Infect Dis Clin N Am. 2009;23(3):571–9.

    Article  Google Scholar 

  3. Napolitano LM. Early appropriate parenteral antimicrobial treatment of complicated skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus. Surg Infect. 2008;9(Suppl 1):s17–27.

    Article  Google Scholar 

  4. Napolitano LM. Perspectives in surgical infections: what does the future hold? Surgical infection society, North America, presidential address. Surg Infect. 2010;11(2):111–23.

    Article  Google Scholar 

  5. DiNubile MJ, Lipsky BA. Complicated infections of skin and skin structures: when the infection is more than skin deep. J Antimicrob Chemother. 2004;53(Suppl 2):ii37–50.

    CAS  PubMed  Google Scholar 

  6. Vinh DC, Embil JM. Severe skin and soft tissue infections and associated critical illness. Curr Infect Dis Rep. 2007;9(5):415–21.

    Article  PubMed  Google Scholar 

  7. Lipsky BA, Moran GJ, Napolitano LM, Vo L, Nicholson S, Kim M. A prospective, multicenter, observational study of complicated skin and soft tissue infections in hospitalized patients: clinical characteristics, medical treatment, and outcomes. BMC Infect Dis. 2012;12:227.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Garau J, Ostermann H, Medina J, Avila M, McBride K, Blasi F, REACH study group. 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. 2013;19(9):E377–85.

    Article  CAS  PubMed  Google Scholar 

  9. http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071185.pdf

  10. Harris AM, Althausen PL, Kellam J, Bosse MJ, Castillo R, Lower Extremity Assessment Project (LEAP) Study Group. Complications following limb-threatening lower extremity trauma. J Orthop Trauma. 2009;23:1–6.

    Article  PubMed  Google Scholar 

  11. Bosse MJ, Murray CK, Carlini AR, et al. METRC assessment of severe extremity wound bioburden at the time of definitive wound closure or coverage: correlation with subsequent Postclosure deep wound infection (bioburden study). J Orthop Trauma. 2017;31:S3–9. https://doi.org/10.1097/BOT.0000000000000805.

    Article  PubMed  Google Scholar 

  12. Thakore RV, Greenberg SE, Shi H, Foxx AM, Francois EL, Prablek MA, Nwosu SK, Archer KR, Ehrenfeld JM, Obremskey WT, Sethi MK. Surgical site infection in orthopedic trauma: a case-control study evaluating risk factors and cost. J Clin Orthop Trauma. 2015;6(4):220–6. https://doi.org/10.1016/j.jcot.2015.04.004. Epub 2015 Jun 18. PMID: 26566333; PMCID: PMC4600831

    Article  PubMed  PubMed Central  Google Scholar 

  13. Paryavi E, Stall A, Gupta R, Scharfstein DO, Castillo RC, Zadnik M, Hui E, O'Toole RV. Predictive model for surgical site infection risk after surgery for high-energy lower extremity fractures: development of the risk of infection in orthopedic trauma surgery score. J Trauma Acute Care Surg. 2013;74(6):1521–7.

    Article  PubMed  Google Scholar 

  14. Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect. 2013;84(1):5–12.

    Article  PubMed  Google Scholar 

  15. Gaynes R, Edwards JR. National Nosocomial Infections Surveillance System: overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis. 2005;41:848–54.

    Article  PubMed  Google Scholar 

  16. Hidron AI, Edwards JR, Patel J, National Healthcare Safety Network Team, Participating National Healthcare Safety Network Facilities, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29:996–1011.

    Article  PubMed  Google Scholar 

  17. Manian FA, Griesnauer S. Community-associated MRSA is replacing traditional healthcare-associated strains in surgical site infections among inpatients. Clin Infect Dis. 2008;47:434–5.

    Article  PubMed  Google Scholar 

  18. Kourbatova EV, Halvosa JS, King MD, et al. Emergence of community-associated MRSA USA 300 clone as a cause of healthcare-associated infections among patients with prosthetic joint infections. Am J Infect Control. 2005;33:385–91.

    Article  PubMed  Google Scholar 

  19. Weigelt JA, Lipsky BA, Tabak YP, et al. Surgical site infections: causative pathogens and associated outcomes. Am J Infect Control. 2010;38:112–20.

    Article  PubMed  Google Scholar 

  20. Haenie M, Podbielski A, Mittelmeier W, et al. Infections after primary and revision total hip replacement caused by enterobacteria producing extended spectrum beta-lactamases (ESBL): a case series. Hip Int. 2010;20(2):248–54.

    Article  Google Scholar 

  21. Martinez-Pastor JC, Vilchez F, Pitart C, et al. Antibiotic resistance in orthopaedic surgery: acute knee prosthetic joint infections due to ESBL-producing Enterobacteriaceae. Eur J Clin Microbiol Infect Dis. 2010;15. [Epub ahead of print]

    Google Scholar 

  22. Gillespie WJ, Walenkamp GH. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev. 2010;3:CD000244.

    Google Scholar 

  23. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA, American Society of Health-System Pharmacists (ASHP), Infectious Diseases Society of America (IDSA), Surgical Infection Society (SIS), Society for Healthcare Epidemiology of America (SHEA). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect. 2013;14(1):73–156. https://doi.org/10.1089/sur.2013.9999.

    Article  Google Scholar 

  24. Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infections in open limb fractures. Cochrane Database Syst Rev. 2004;1:CD003764.

    Google Scholar 

  25. Hauser CJ, Adams CA Jr, Eachempati SR. Council of the Surgical Infection Society. Surgical infection society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline. Surg Infect. 2006;7(4):379–405.

    Article  Google Scholar 

  26. Glass GE, Barrett SP, Sanderson F, et al. The microbiological basis for a revised antibiotic regimen in high-energy tibial fractures: preventing deep infections by nosocomial organisms. J Plast Reconstr Aesthet Surg. 2010; Jun 28. [Epub ahead of print]

    Google Scholar 

  27. Sarkar B, Napolitano LM. Necrotizing soft tissue infections. Minerva Chir. 2010;65(3):347–62.

    CAS  PubMed  Google Scholar 

  28. Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279–88.

    Article  PubMed  Google Scholar 

  29. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705–10.

    Article  CAS  PubMed  Google Scholar 

  30. Cainzos M, Gonzalez-Rodriguez FJ. Necrotizing soft tissue infections. Curr Opin Crit Care. 2007;13(4):433–9.

    Article  PubMed  Google Scholar 

  31. Yilmazlar T, Ozturk E, Alsoy A, Ozquc H. Necrotizing soft tissue infections: APACHE II score, dissemination, and survival. World J Surg. 2007;31(9):1858–62.

    Article  PubMed  Google Scholar 

  32. Cuschieri J. Necrotizing soft tissue infection. Surg Infect. 2008;9(6):559–62.

    Article  Google Scholar 

  33. Anaya DA, McMahon K, Nathens AB, et al. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg. 2005;140:151–7.

    Article  PubMed  Google Scholar 

  34. Faraklas I, Stoddard GJ, Neumayer LA, Cochran A. Development and validation of a necrotizing soft-tissue infection mortality risk calculator using NSQIP. J Am Coll Surg. 2013;217(1):153–60.e3; discussion 160-1

    Article  PubMed  Google Scholar 

  35. Wong CH, Khin LW, Heng KS, et al. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.

    Article  PubMed  Google Scholar 

  36. Laboratory risk indicator for necrotizing fasciitis score and the outcomes. [ANZ J Surg. 2008].

    Google Scholar 

  37. Su YC, Chen HW, Hong YC, et al. Laboratory risk indicator for necrotizing fasciitis score and the outcomes. ANZ J Surg. 2008;78(11):968–72.

    Article  PubMed  Google Scholar 

  38. Struk DW, Munk PL, Lee MJ, et al. Imaging of soft tissue infections. Radiol Clin N Am. 2001;39(2):277–303.

    Article  CAS  PubMed  Google Scholar 

  39. Brothers TE, Tagge DU, Stutley JE, et al. Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg. 1998;187:416–21.

    Article  CAS  PubMed  Google Scholar 

  40. Malghem J, Lecouvet FE, Omoumi P, Maldague BE, Vande Berg BC. Necrotizing fasciitis: contribution and limitations of diagnostic imaging. Joint Bone Spine. 2013;80(2):146–54.

    Article  PubMed  Google Scholar 

  41. Kim KT, Kim YJ, Won Lee J, Kim YJ, Park SW, Lim MK, Suh CH. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology. 2011;259(3):816–24.

    Article  PubMed  Google Scholar 

  42. Wong CH, Chang HC, Pasupathy S, et al. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85-A(8):1454–60.

    Article  Google Scholar 

  43. McHenry CR, Piotrowski JJ, Petrinic D, et al. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Elhabash S, Lee L, Farrow B, et al. Characteristics and microbiology of patients presenting with necrotizing fasciitis. Presented at the Association of VA Surgeons 31st Annual Meeting. Little Rock: Arkansas; May 10–12, 2007.

    Google Scholar 

  45. Lee TC, Carrick MM, Scott BG, et al. Incidence and clinical characteristics of MRSA necrotizing fasciitis in a large urban hospital. Am J Surg. 2007;194(6):809–12.

    Article  PubMed  Google Scholar 

  46. Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated MRSA in Los Angeles. N Engl J Med. 2005;352(14):1445–53.

    Article  CAS  PubMed  Google Scholar 

  47. Young LM, Price CS. Community-acquired MRSA emerging as an important cause of necrotizing fasciitis. Surg Infect. 2008;9(4):469–74.

    Article  Google Scholar 

  48. Olsen RJ, Burns KM, Chen L, et al. Severe necrotizing fasciitis in a human immunodeficiency virus-positive patient caused by MRSA. J Clin Microbiol. 2008;46(3):1144–7.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Dehority W, Wang E, Vernon PS, et al. Community-associated MRSA necrotizing fasciitis in a neonate. Pediatr Infect Dis J. 2006;25(11):1080–1.

    Article  PubMed  Google Scholar 

  50. Tsai YH, Hsu RW, Huang TJ, et al. Necrotizing soft tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species. J Bone Joint Surg Am. 2007;89(3):631–6.

    Article  PubMed  Google Scholar 

  51. Tsai YH, Hsu RW, Huang KC, et al. Systemic vibrio infection presenting as necrotizing fasciitis and sepsis. A series of 13 cases. J Bone Joint Surg Am. 2004;86(11):2497–502.

    Article  PubMed  Google Scholar 

  52. Minnaganti VR, Patel PJ, Iancu D, et al. Necrotizing fasciitis caused by Aeromonas hydrophila. Heart Lung. 2000;29(4):306–8.

    Article  CAS  PubMed  Google Scholar 

  53. Vibrio vulnificus infection: diagnosis and treatment. Am Fam Physician. 2007;76(4):539–44.

    Google Scholar 

  54. Tsai YH, Huang TJ, Hsu RW, et al. Necrotizing soft tissue infections and primary sepsis caused by Vibrio vulnificus and vibrio cholerae non-O1. J Trauma. 2009;66(3):899–905.

    PubMed  Google Scholar 

  55. Kuo YL, Shieh SJ, Chiu HY, Lee JW. Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. Eur J Clin Microbiol Infect Dis. 2007;26(11):785–92.

    Article  PubMed  Google Scholar 

  56. Chao WN, Tsai SJ, Tsai CF, Su CH, Chan KS, Lee YT, Ueng KC, Lin DB, Chen CC, Chen SC. The laboratory risk indicator for necrotizing fasciitis score for discernment of necrotizing fasciitis originated from Vibrio vulnificus infections. J Trauma Acute Care Surg. 2012;73(6):1576–82.

    Article  PubMed  Google Scholar 

  57. Brook I. Microbiology and management of myositis. Int Orthop. 2004;28(5):257–60.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Garcia J. MRI in inflammatory myopathies. Skelet Radiol. 2000;29:425–38.

    Article  CAS  Google Scholar 

  59. Govaert GAM, Kuehl R, Atkins BL, Trampuz A, Morgenstern M, Obremskey WT, Verhofstad MHJ, McNally MA, Metsemakers W-J, on behalf of the Fracture-Related Infection (FRI) Consensus Group. Diagnosing fracture-related infection: current concepts and recommendations. J Orthop Trauma. 2020;34(1):8–17. https://doi.org/10.1097/BOT.0000000000001614.

    Article  PubMed  Google Scholar 

  60. Metsemakers WJ, Kortram K, Morgenstern M, et al. Definition of infection after fracture fixation: a systematic review of randomized controlled trials to evaluate current practice. Injury. 2018;49:497–504.

    Article  CAS  PubMed  Google Scholar 

  61. Metsemakers WJ, Moriarty TF, Morgenstern M, et al. Letter to the editor: new definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res. 2016;474:2726–7.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Depypere M, Kuehl R, Metsemakers WJ, et al. Recommendations for systemic antimicrobial therapy in fracture-related infection: a consensus from an international expert group. J Orthop Trauma. 2020;34(1):30–41. https://doi.org/10.1097/BOT.0000000000001626.

    Article  PubMed  Google Scholar 

  63. O’Toole RV, Joshi M, Carlini AR, et al. Local antibiotic therapy to reduce infection after operative treatment of fractures at high risk of infection: a multicenter, randomized, controlled trial (VANCO study). J Ortho Trauma. 2017;31:S18–24.

    Article  Google Scholar 

  64. Qadir R, Costales T, Coale M, et al. Vancomycin powder use in fractures at high risk of surgical site infection. J Orthop Trauma. 2021;35:23–8.

    Article  PubMed  Google Scholar 

  65. Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004;364(9431):369–79.

    Article  CAS  PubMed  Google Scholar 

  66. Bosse MJ, MacKenzie EJ, Kellam JF, et al. An analysis of outcomes of reconstruction or amputation of leg-threatening injuries. N Engl J Med. 2002;247(24):1924–31.

    Article  Google Scholar 

  67. Spellberg B, Lipsky BA. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis. 2012;54(3):393–407.

    Article  PubMed  Google Scholar 

  68. Fily F, Ronat JB, Malou N, et al. Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006-2016. BMC Infect Dis. 2019;19(1):103. Published 2019 Jan 31. https://doi.org/10.1186/s12879-019-3741-9.

    Article  PubMed  PubMed Central  Google Scholar 

  69. May AK. Skin and soft tissue infections. Surg Clin North Am. 2009;89(2):403–20.

    Article  PubMed  Google Scholar 

  70. Chan T, Yaghoubian A, Rosing D, et al. Low sensitivity of physical examination findings in necrotizing soft tissue infection is improved with laboratory values: a prospective study. Am J Surg. 2008;196(6):926–30. discussion 930

    Article  PubMed  Google Scholar 

  71. Wall DB, deVirgilio C, Black S, Klein SR. Objective criteria may assist in distinguishing necrotizing fasciitis from non-necrotizing soft tissue infection. Am J Surg. 2000;179(11):17–21.

    Article  CAS  PubMed  Google Scholar 

  72. Wall DB, Klein SR, Black S, deVirgilio C. A simple model to help distinguish necrotizing fasciitis from non-necrotizing soft tissue infections. J Am Coll Surg. 2000;191(3):227–31.

    Article  CAS  PubMed  Google Scholar 

  73. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999;115:462–74.

    Article  CAS  PubMed  Google Scholar 

  74. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262–8.

    Article  PubMed  Google Scholar 

  75. Garnacho-Montero J. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med. 2003;31:2742–51.

    Article  PubMed  Google Scholar 

  76. Alvarez-Lerma F, the ICU-Acquired Pneumonia Study Group. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. Intensive Care Med. 1996;22:387–94.

    Article  CAS  PubMed  Google Scholar 

  77. Ruhe JJ, Smith N, Bradsher RW, Menon A. Community-onset methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: impact of antimicrobial therapy on outcome. Clin Infect Dis. 2007;44:777–84.

    Article  CAS  PubMed  Google Scholar 

  78. Schramm GE, Johnson JA, Doherty JA, Micek ST, Kollef MH. Methicillin-resistant Staphylococcus aureus sterile-site infection: the importance of appropriate initial antimicrobial treatment. Crit Care Med. 2006;34(8):2069–74.

    Article  PubMed  Google Scholar 

  79. Chuck EA, Frazee BW, Lambert L, McCabe R. The benefit of empiric treatment for methicillin-resistant Staphylococcus aureus. J Emerg Med. 2010 Jun;38(5):567–71.

    Article  PubMed  Google Scholar 

  80. Gorwitz RJ, Jernigan DB, Powers JH, Jernigan JA and Participants in the CDC-Convened Experts’ Meeting on Management of MRSA in the Community. Strategies for clinical management of MRSA in the community: Summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. 2006. http://198.246.98.21/ncidod/dhqp/pdf/ar/CAMRSA_ExpMtgStrategies.pdf.

  81. Rhodes A, Evans L, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for Management of Sepsis and Septic Shock 2016. Crit Care Med. 2017;45(3):486–552. https://doi.org/10.1097/CCM.0000000000002255.

    Article  PubMed  Google Scholar 

  82. Rhodes A, Evans LE, Dellinger RP, et al. Surviving sepsis campaign: international guidelines for Management of Sepsis and Septic Shock 2016. Intensive Care Med. 2017;43:304–77. https://doi.org/10.1007/s00134-017-4683-6.

    Article  PubMed  Google Scholar 

  83. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.

    Article  PubMed  Google Scholar 

  84. Brook I. Microbiology and management of soft tissue and muscle infections. Int J Surg. 2008;6(4):328–38.

    Article  PubMed  Google Scholar 

  85. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003;290:2976–84.

    Article  CAS  PubMed  Google Scholar 

  86. Crum NF, Lee RU, Thornton SA, et al. Fifteen year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. Am J Med. 2006;119:943–51.

    Article  PubMed  Google Scholar 

  87. Moran GJ, Krishnadasan A, Gorwitz RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355(7):666–74.

    Article  CAS  PubMed  Google Scholar 

  88. Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352(14):1445–53.

    Article  CAS  PubMed  Google Scholar 

  89. Frazee BW, Lynn J, Charlebois ED, et al. High prevalence of methicillin-resistant in emergency department skin and soft tissue infection. Ann Emerg Med. 2005;45:311–20.

    Article  PubMed  Google Scholar 

  90. King MD, Humphrey BJ, Wang YF. Emergence of community acquired methicillin-resistant staphylococcus aureus USA 300 clone as the prdominant cause of skin and soft-tissue infections. Ann Intern Med. 2006;144:309–17.

    Article  PubMed  Google Scholar 

  91. Ray GT, Suaya JA, Baxter R. Microbiology of skin and soft tissue infections in the age of community-acquired methicillin-resistant Staphylococcus aureus. Diagn Microbiol Infect Dis. 2013;76(1):24–30.

    Article  PubMed  Google Scholar 

  92. Moran GJ, Abrahamian FM, Lovecchio F, Talan DA. Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines. J Emerg Med. 2013;44(6):e397–412.

    Article  PubMed  Google Scholar 

  93. Tattevin P, Schwartz BS, Graber CJ, Volinski J, Bhukhen A, Bhukhen A, Mai TT, Vo NH, Dang DN, Phan TH, Basuino L, Perdreau-Remington F, Chambers HF, Diep BA. Concurrent epidemics of skin and soft tissue infection and bloodstream infection due to community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2012;55(6):781–8.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Awad SS, Elhabash SI, Lee L, et al. Increasing incidence of methicillin-resistant Staphylococcus aureus skin and soft tissue infections: reconsideration of empiric antimicrobial therapy. Am J Surg. 2007;194:606–10.

    Article  CAS  PubMed  Google Scholar 

  95. Hidayat LK, Hsu DI, Quist R, et al. High-dose vancomycin for methicillin-resistant Staphylococcus aureus infections. Arch Intern Med. 2006;166:2138–44.

    Article  PubMed  Google Scholar 

  96. Howden BP, Ward PB, Charles PGP, et al. Treatment outcomes for serious infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility. Clin Infect Dis. 2004;38:521–8.

    Article  CAS  PubMed  Google Scholar 

  97. Lipsky BA, Weigelt JA, Gupta V, et al. Skin, soft tissue, bone and joint infections in hospitalized patients: epidemiology and microbiological, clinical and economic outcomes. Infect Control Hosp Epidemiol. 2007;28(11):1290–8.

    Article  PubMed  Google Scholar 

  98. Stevens DL, Bisno AL, Chambers HF, et al. Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections. Clin Infect Dis. 2005;41(10):1373–406.

    Article  PubMed  Google Scholar 

  99. Reber A, Moldovan A, Dunkel N, Emonet S, Rohner P, Tahintzi P, Hoffmeyer P, Harbarth S, Uçkay I. Should the methicillin-resistant Staphylococcus aureus carriage status be used as a guide to treatment for skin and soft tissue infections? J Infect. 2012;64(5):513–9.

    Article  PubMed  Google Scholar 

  100. Duane TM, Huston JM, Collom M, et al. Surgical infection society 2020 updated guidelines on the management of complicated skin and soft tissue infections. Surg Infect. 2021;22:1–17.

    Article  Google Scholar 

  101. Napolitano LM. Early appropriate parenteral antimicrobial treatment of complicated skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus. Surg Infect. 2008;9(Suppl 1):S15-27.

    Google Scholar 

  102. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52:1–38.

    Article  Google Scholar 

  103. Prokocimer P, De Anda C, Fang E, Mehra P, Das A. Tedizolid phosphate vs linezolid for treatment of acute bacterial skin and skin structure infections: the ESTABLISH-1 randomized trial. JAMA. 2013;309(6):559–69.

    Article  CAS  PubMed  Google Scholar 

  104. Gurusamy KS, Koti R, Toon CD, Wilson P, Davidson BR. Antibiotic therapy for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in surgical wounds. Cochrane Database Syst Rev. 2013;8:CD009726.

    Google Scholar 

  105. Gurusamy KS, Koti R, Toon CD, Wilson P, Davidson BR. Antibiotic therapy for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) in non surgical wounds. Cochrane Database Syst Rev. 2013;11:CD010427.

    Google Scholar 

  106. Stevens DL, Ma Y, Salmi DB, McIndoo E, Wallace RJ, Bryant AE. Impact of antibiotics on expression of virulence-associated exotoxin genes in methicillin-sensitive and methicillin-resistant Staphylococcus aureus. J Infect Dis. 2007;195:202–11.

    Article  CAS  PubMed  Google Scholar 

  107. Wang R, et al. Identification of novel cytolytic peptides as key virulence determinants for community-associated MRSA. Nat Med. 2007;13(12):1510–4.

    Article  CAS  PubMed  Google Scholar 

  108. Filbin MR, Ring DC, Wessels MR, et al. Case 2-2009: a 25 year-old man with pain and swelling of the right hand and hypotension. N Engl J Med. 2009;360:281–90.

    Article  CAS  PubMed  Google Scholar 

  109. Marshall JC, Maier RV, Jimenez M, Dellinger EP. Source control in the management of severe sepsis and septic shock: an evidence-based review. Crit Care Med. 2004;32(11 Suppl):S513–26.

    Article  PubMed  Google Scholar 

  110. Laterre PF. Progress in medical management of intra-abdominal infections. Curr Opin Infect Dis. 2008;21(4):393–8.

    Article  PubMed  Google Scholar 

  111. Kuo DC, Chasm RM, Witting MD. Emergency department physician ability to predict methicillin-resistant Staphylococcus aureus skin and soft tissue infections. J Emerg Med. 2010;39(1):17–20.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Michigan, Ann Arbor, MI, USA

    Lena M. Napolitano

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  1. Lena M. Napolitano
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Correspondence to Lena M. Napolitano .

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Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

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Napolitano, L.M. (2022). Surgical Management: Acute Soft Tissue and Bone Infections. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_32

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  • DOI: https://doi.org/10.1007/978-3-030-95906-7_32

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