What Is New in the Management of Skin and Soft Tissue Infections in 2016?

Garyphallia Poulakou; Efthymia Giannitsioti; Sotirios Tsiodras

Disclosures

Curr Opin Infect Dis. 2017;30(2):158-171. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Skin and soft tissue infections (SSTIs) are the most frequent infectious cause of referrals to emergency departments and hospital admissions in developed world, contributing to significant morbidity and healthcare expenditures. We sought to review recent literature covering epidemiology and management of SSTIs.

Recent findings Incidence trends of SSTIs were increasing worldwide with Staphylococcus aureus and streptococci predominating and methicillin-resistant S. aureus (MRSA) posing additional challenges, because of high rates of treatment failure and relapse. Development of new antimicrobials was associated with an appraisal of regulatory definitions and endpoints. Prediction of clinical response can be very tricky, because of variable risk factors for recurrence or treatment failure, depending mostly on the host. Precise indications for new antimicrobials should be established; their integration into clinical practice algorithms may serve reduction of unnecessary admissions, overtreatment and total costs.

Summary New antimicrobials with activity against MRSA have been recently launched. Long-acting agents, mainly oritavancin and dalbavancin, provide the opportunity of single-dose treatment and early discharge. Further outpatient treatment options include new per os antibiotics such as oxazolidinones. Validated assessment tools are urgently needed to support decision-making toward rational resource utilization and delivery of optimal treatment.

Introduction

Skin and soft tissue infection (SSTI) represents one of the most common causes of referral to the emergency department (ED) and one of the most common infectious causes of hospital admissions. A strong recent increasing incidence trend was mainly attributed to the expansion of aging population with comorbidities and the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).[1,2] In the United States, according to the National Hospital Ambulatory Medical Care Survey database ED, visits for uncomplicated SSTIs (uSSTIs) almost doubled between 1993 and 2005 (from 1.35 to 2.98%, P < 0.001).[3] In addition, according to the Healthcare Cost and Utilization Project National Inpatient Sample, hospital admissions for SSTIs in the United States increased by 30% between 2000 and 2004, most notably because of superficial infections in adults less than 65 years of age.[4] Children's Inpatient Databases, showed a 2.5-fold increase in incidence of SSTIs, from 23.2 in 2000 to 62.7 in 2006 per 100 000 pediatric patients.[5] Similarly, a three-fold increase in admissions because of abscesses, furuncles, carbuncles and cellulitis was recorded in the UK between 1990 and 2004.[6] The increased prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has introduced additional therapeutic challenges in both hospital and outpatient settings. SSTIs have a large array of clinical features ranging from superficial infections of the skin to bacteremic and possibly life-threatening infections.[1,7] This article will review the literature published between June 2015 and December 2016, focusing on epidemiology and management of SSTIs and taking into consideration the 'hot topics' that were identified in a recent publication from experts of the SSTI Working Group of the International Society of Chemotherapy.[8]

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