How are hospital-acquired skin and soft-tissue infections (SSTIs) treated in immunocompromised patients?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Immunocompromised patients may acquire infections in the hospital, which can present a therapeutic challenge because of the emergence of resistant gram-positive and gram-negative bacteria. In general, severely ill or toxic patients require very broad-spectrum empiric agents that are effective against resistant gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA); these antimicrobials include vancomycin, linezolid, daptomycin, and quinupristin-dalfopristin. [2] Ceftaroline is a newer, advanced-generation cephalosporin that includes coverage for MRSA and that has received FDA approval for treatment of SSTIs.

Gram-negative bacterial coverage includes monotherapy with a cephalosporin effective against strains of Pseudomonas (if such concerns exist with a patient), carbapenems, or a combination of either a fluoroquinolone or an aminoglycoside (monitor renal function), plus either an extended-spectrum penicillin or a cephalosporin. [2]


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