Skip to main content
SpringerLink
Log in

Skin and Soft Tissue Infection

  • Chapter
  • First Online:
The Infectious Diseases Consult Handbook

  • 279 Accesses

Abstract

In many ways, the skin is the first barrier to infection. Despite colonization with a dermal microbiome, the skin prevents penetration of bacteria into the deeper tissues. Disruption of this barrier due to trauma, chemotherapy, or other processes can result in infection. Even in immunocompetent hosts, infections of the cutaneous and subcutaneous tissues such as cellulitis and abscesses are common. Skin and soft tissue infections can become dangerous if not managed appropriately. In addition, as a relatively common occurrence, you will no doubt be consulted about skin and soft tissue infections frequently during your time on the ID service.

In this chapter, we will discuss the diagnosis and management of cellulitis, different treatment options for cutaneous abscesses, prosthetic soft tissue device infections, and the treatment of animal bites.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, EJC G, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC, Infectious Diseases Society of America. 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. https://doi.org/10.1093/cid/ciu444.

    Article  PubMed  Google Scholar 

  2. Jenkins TC, Knepper BC, Jason Moore S, Saveli CC, Pawlowski SW, Perlman DM, McCollister BD, Burman WJ. Comparison of the microbiology and antibiotic treatment among diabetic and nondiabetic patients hospitalized for cellulitis or cutaneous abscess. J Hosp Med. 2014;9:788–94. https://doi.org/10.1002/jhm.2267.

    Article  PubMed  Google Scholar 

  3. Manfredi R, Calza L, Chiodo F. Epidemiology and microbiology of cellulitis and bacterial soft tissue infection during HIV disease: a 10-year survey. J Cutan Pathol. 2002;29:168–72. https://doi.org/10.1034/j.1600-0560.2002.290307.x.

    Article  PubMed  Google Scholar 

  4. Strazzula L, Cotliar J, Fox LP, Hughey L, Shinkai K, Gee SN, Kroshinsky D. Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: a multi-institutional analysis. J Am Acad Dermatol. 2015;73:70–5. https://doi.org/10.1016/j.jaad.2014.11.012.

    Article  PubMed  Google Scholar 

  5. Weng QY, Raff AB, Cohen JM, Gunasekera N, Okhovat J-P, Vedak P, Joyce C, Kroshinsky D, Mostaghimi A. Costs and consequences associated with misdiagnosed lower extremity cellulitis. JAMA Dermatol. 2017;153:141–6. https://doi.org/10.1001/jamadermatol.2016.3816.

    Article  PubMed  Google Scholar 

  6. Raff AB, Weng QY, Cohen JM, Gunasekera N, Okhovat J-P, Vedak P, Joyce C, Kroshinsky D, Mostaghimi A. A predictive model for diagnosis of lower extremity cellulitis: a cross-sectional study. J Am Acad Dermatol. 2017;76:618–625.e2. https://doi.org/10.1016/j.jaad.2016.12.044.

    Article  PubMed  Google Scholar 

  7. Li DG, Dewan AK, Xia FD, Khosravi H, Joyce C, Mostaghimi A. The ALT-70 predictive model outperforms thermal imaging for the diagnosis of lower extremity cellulitis: a prospective evaluation. J Am Acad Dermatol. 2018;79:1076–1080.e1. https://doi.org/10.1016/j.jaad.2018.06.062.

    Article  PubMed  Google Scholar 

  8. Walker TD, Gilkey TW, Trinidad JC, Chung CG, Wang H, Mostaghimi A, Kaffenberger BH. Evaluation of Dundee and ALT-70 predictive models for cellulitis in 56 patients who underwent tissue culture. Arch Dermatol Res. 2023;315:665–8. https://doi.org/10.1007/s00403-022-02409-0.

    Article  PubMed  Google Scholar 

  9. Webb E, Neeman T, Bowden FJ, Gaida J, Mumford V, Bissett B. Compression therapy to prevent recurrent cellulitis of the leg. N Engl J Med. 2020;383:630–9. https://doi.org/10.1056/NEJMoa1917197.

    Article  CAS  PubMed  Google Scholar 

  10. Thomas KS, Crook AM, Nunn AJ, Foster KA, Mason JM, Chalmers JR, Nasr IS, Brindle RJ, English J, Meredith SK, Reynolds NJ, de Berker D, Mortimer PS, Williams HC, U.K. Dermatology Clinical Trials Network’s PATCH I Trial Team. Penicillin to prevent recurrent leg cellulitis. N Engl J Med. 2013;368:1695–703. https://doi.org/10.1056/NEJMoa1206300.

    Article  CAS  PubMed  Google Scholar 

  11. Schaverien MV, Baumann DP, Selber JC, Chang EI, Hanasono MM, Chu C, Hanson SE, Butler CE. Building a multidisciplinary comprehensive academic lymphedema program. Plast Reconstr Surg Glob Open. 2020;8:e2670. https://doi.org/10.1097/GOX.0000000000002670.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gaspari RJ, Resop D, Mendoza M, Kang T, Blehar D. A randomized controlled trial of incision and drainage versus ultrasonographically guided needle aspiration for skin abscesses and the effect of methicillin-resistant Staphylococcus aureus. Ann Emerg Med. 2011;57:483–491.e1. https://doi.org/10.1016/j.annemergmed.2010.11.021.

    Article  PubMed  Google Scholar 

  13. Daum RS, Miller LG, Immergluck L, Fritz S, Creech CB, Young D, Kumar N, Downing M, Pettibone S, Hoagland R, Eells SJ, Boyle MG, Parker TC, Chambers HF, DMID 07-0051 Team. A placebo-controlled trial of antibiotics for smaller skin abscesses. N Engl J Med. 2017;376:2545–55. https://doi.org/10.1056/NEJMoa1607033.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Gottlieb M, DeMott JM, Hallock M, Peksa GD. Systemic antibiotics for the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. Ann Emerg Med. 2019;73:8–16. https://doi.org/10.1016/j.annemergmed.2018.02.011.

    Article  PubMed  Google Scholar 

  15. Moran GJ, Fang E, Corey GR, Das AF, De Anda C, Prokocimer P. Tedizolid for 6 days versus linezolid for 10 days for acute bacterial skin and skin-structure infections (ESTABLISH-2): a randomised, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis. 2014;14:696–705. https://doi.org/10.1016/S1473-3099(14)70737-6.

    Article  CAS  PubMed  Google Scholar 

  16. Campos JM, Charilaou CC. Evaluation of detect-A-strep and the culturette ten-minute strep ID kits for detection of group a streptococcal antigen in oropharyngeal swabs from children. J Clin Microbiol. 1985;22:145–8. https://doi.org/10.1128/jcm.22.2.145-148.1985.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bowen AC, Lilliebridge RA, Tong SYC, Baird RW, Ward P, McDonald MI, Currie BJ, Carapetis JR. Is streptococcus pyogenes resistant or susceptible to trimethoprim-sulfamethoxazole? J Clin Microbiol. 2012;50:4067–72. https://doi.org/10.1128/JCM.02195-12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Gelfand MS, Cleveland KO, Ketterer DC. Susceptibility of streptococcus pyogenes to trimethoprim-sulfamethoxazole. J Clin Microbiol. 2013;51:1350. https://doi.org/10.1128/JCM.03329-12.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bowen AC, Carapetis JR, Currie BJ, Fowler V, Chambers HF, Tong SYC. Sulfamethoxazole-trimethoprim (Cotrimoxazole) for skin and soft tissue infections including impetigo, cellulitis, and abscess. Open Forum Infect Dis. 2017;4:ofx232. https://doi.org/10.1093/ofid/ofx232.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Jemec GBE. Clinical practice. Hidradenitis suppurativa. N Engl J Med. 2012;366:158–64. https://doi.org/10.1056/NEJMcp1014163.

    Article  CAS  PubMed  Google Scholar 

  21. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, Crowell K, Eisen DB, Gottlieb AB, Hamzavi I, Hazen PG, Jaleel T, Kimball AB, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81:91–101. https://doi.org/10.1016/j.jaad.2019.02.068.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kimball AB, Okun MM, Williams DA, Gottlieb AB, Papp KA, Zouboulis CC, Armstrong AW, Kerdel F, Gold MH, Forman SB, Korman NJ, Giamarellos-Bourboulis EJ, Crowley JJ, Lynde C, Reguiai Z, Prens E-P, Alwawi E, Mostafa NM, Pinsky B, Sundaram M, Gu Y, Carlson DM, Jemec GBE. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375:422–34. https://doi.org/10.1056/NEJMoa1504370.

    Article  CAS  PubMed  Google Scholar 

  23. Lalani T. Breast implant infections: an update. Infect Dis Clin N Am. 2018;32:877–84. https://doi.org/10.1016/j.idc.2018.06.007.

    Article  Google Scholar 

  24. Seng P, Bayle S, Alliez A, Romain F, Casanova D, Stein A. The microbial epidemiology of breast implant infections in a regional referral Centre for plastic and reconstructive surgery in the south of France. Int J Infect Dis. 2015;35:62–6. https://doi.org/10.1016/j.ijid.2015.04.010.

    Article  PubMed  Google Scholar 

  25. Jhaveri VV, Singhal D, Riedel S, Rowley CF, Nathavitharana RR. Surgical cure of clarithromycin resistant mycobacterium chelonae breast implant infection: a case report and review of the literature. J Clin Tuberc Other Mycobact Dis. 2020;21:100183. https://doi.org/10.1016/j.jctube.2020.100183.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bramhall RJ, Hernan I, Harris PA. A single-Centre, retrospective proof-of-concept review of salvage of infected or exposed implant breast reconstructions with explantation and one-stage free flap replacement. J Plast Reconstr Aesthet Surg. 2018;71:194–200. https://doi.org/10.1016/j.bjps.2017.10.009.

    Article  PubMed  Google Scholar 

  27. Mirzabeigi MN, Mericli AF, Ortlip T, Tuma GA, Copit SE, Fox JW, Moore JH. Evaluating the role of postoperative prophylactic antibiotics in primary and secondary breast augmentation: a retrospective review. Aesthet Surg J. 2012;32:61–8. https://doi.org/10.1177/1090820X11430830.

    Article  PubMed  Google Scholar 

  28. Franchelli S, Pesce M, Baldelli I, Marchese A, Santi P, De Maria A. Analysis of clinical management of infected breast implants and of factors associated to successful breast pocket salvage in infections occurring after breast reconstruction. Int J Infect Dis. 2018;71:67–72. https://doi.org/10.1016/j.ijid.2018.03.019.

    Article  PubMed  Google Scholar 

  29. Tuckel PS, Milczarski W. The changing epidemiology of dog bite injuries in the United States, 2005-2018. Inj Epidemiol. 2020;7:57. https://doi.org/10.1186/s40621-020-00281-y.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Benson LS, Edwards SL, Schiff AP, Williams CS, Visotsky JL. Dog and cat bites to the hand: treatment and cost assessment. J Hand Surg Am. 2006;31:468–73. https://doi.org/10.1016/j.jhsa.2005.12.011.

    Article  PubMed  Google Scholar 

  31. Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJC. Bacteriologic analysis of infected dog and cat bites. N Engl J Med. 1999;340:85–92. https://doi.org/10.1056/NEJM199901143400202.

    Article  CAS  PubMed  Google Scholar 

  32. Rothe K, Tsokos M, Handrick W. Animal and human bite wounds. Dtsch Arztebl Int. 2015;112:433–43. https://doi.org/10.3238/arztebl.2015.0433.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ellis R, Ellis C. Dog and cat bites. Am Fam Physician. 2014;90:239–43.

    PubMed  Google Scholar 

  34. Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med. 1994;23:535–40. https://doi.org/10.1016/s0196-0644(94)70073-7.

    Article  CAS  PubMed  Google Scholar 

  35. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001:CD001738. https://doi.org/10.1002/14651858.CD001738.

  36. Blanche P, Bloch E, Sicard D. Capnocytophaga canimorsus in the oral flora of dogs and cats. J Infect. 1998;36:134. https://doi.org/10.1016/s0163-4453(98)93918-4.

    Article  CAS  PubMed  Google Scholar 

  37. Janda JM, Graves MH, Lindquist D, Probert WS. Diagnosing Capnocytophaga canimorsus infections. Emerg Infect Dis. 2006;12:340–2. https://doi.org/10.3201/eid1202.050783.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Popiel KY, Vinh DC. “Bobo-Newton syndrome”: an unwanted gift from man’s best friend. Can J Infect Dis Med Microbiol. 2013;24:209–14. https://doi.org/10.1155/2013/930158.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Smeets NJL, Fijnheer R, Sebastian S, De Mast Q. Secondary thrombotic microangiopathy with severely reduced ADAMTS13 activity in a patient with Capnocytophaga canimorsus sepsis: a case report. Transfusion. 2018;58:2426–9. https://doi.org/10.1111/trf.14829.

    Article  PubMed  Google Scholar 

  40. Jolivet-Gougeon A, Sixou J-L, Tamanai-Shacoori Z, Bonnaure-Mallet M. Antimicrobial treatment of Capnocytophaga infections. Int J Antimicrob Agents. 2007;29:367–73. https://doi.org/10.1016/j.ijantimicag.2006.10.005.

    Article  CAS  PubMed  Google Scholar 

  41. Bertin N, Brosolo G, Pistola F, Pelizzo F, Marini C, Pertoldi F, Vriz O. Capnocytophaga canimorsus: an emerging pathogen in immunocompetent patients—experience from an emergency department. J Emerg Med. 2018;54:871–5. https://doi.org/10.1016/j.jemermed.2018.01.042.

    Article  PubMed  Google Scholar 

  42. Page LK, Anchor C, Luy E, Kron S, Larson G, Madsen L, Kellner K, Smyser TJ. Backyard raccoon latrines and risk for Baylisascaris procyonis transmission to humans. Emerg Infect Dis. 2009;15:1530–1. https://doi.org/10.3201/eid1509.090128.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Strausbaugh LJ, Murray WJ, Kazacos KR. Raccoon roundworm encephalitis. Clin Infect Dis. 2004;39:1484–92. https://doi.org/10.1086/425364.

    Article  Google Scholar 

  44. Zhou X, Xie Y, Zhang Z, Wang C, Sun Y, Gu X, Wang S, Peng X, Yang G. Analysis of the genetic diversity of the nematode parasite Baylisascaris schroederi from wild giant pandas in different mountain ranges in China. Parasit Vectors. 2013;6:233. https://doi.org/10.1186/1756-3305-6-233.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Jenkins SR, Perry BD, Winkler WG. Ecology and epidemiology of raccoon rabies. Rev Infect Dis. 1988;10(Suppl 4):S620–5. https://doi.org/10.1093/clinids/10.supplement_4.s620.

    Article  PubMed  Google Scholar 

  46. Vora NM, Basavaraju SV, Feldman KA, Paddock CD, Orciari L, Gitterman S, Griese S, Wallace RM, Said M, Blau DM, Selvaggi G, Velasco-Villa A, Ritter J, Yager P, Kresch A, Niezgoda M, Blanton J, Stosor V, Falta EM, Lyon GM, Zembower T, Kuzmina N, Rohatgi PK, Recuenco S, Zaki S, Damon I, Franka R, Kuehnert MJ. Raccoon rabies virus variant transmission through solid organ transplantation. JAMA. 2013;310:398–407. https://doi.org/10.1001/jama.2013.7986.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA

    Alexander M. Tatara

Authors
  1. Alexander M. Tatara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander M. Tatara .

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tatara, A.M. (2023). Skin and Soft Tissue Infection. In: The Infectious Diseases Consult Handbook. Springer, Cham. https://doi.org/10.1007/978-3-031-39474-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-39474-4_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-39473-7

  • Online ISBN: 978-3-031-39474-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation