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

Diagnosis

Diagnosis of uSSTIs such as erysipelas and cellulitis relies often on clinical features only. Specimens for culture can be taken in purulent SSTIs or in lesions undergoing surgical incision and/or debridement or imaging-guided drainage.[9] Optimal sampling for microbiology is advisable via surgical procedure from the area of peripheral expansion of the lesion. However, in some uSSTIs, surgical incision and drainage may be adequate treatment; in a recent meta-analysis encompassing 1969 patients, the antimicrobial treatment did not confer any additional benefit.[47] Superficial sampling with swabs and particularly in chronic-infected ulcers can overestimate as 'true pathogens' microorganisms that represent colonization. Blood cultures are rarely positive in SSTIs and are recommended in patients with underlying comorbidities and systematic inflammatory response.[9,48] Recent studies in pediatric patients with uSSTI argue against the necessity of blood cultures as routine practice.[49,50] Accumulating data have emphasized the role of ultrasound applications as an important adjunctive diagnostic tool in the management of SSTIs in the ED. Ultrasound may guide drainage and microbiological sampling, assessment of disease proliferation and the need for surgical intervention and ultimately may contribute to selection of appropriate treatment.[51–53] In a prospective study of 151 pediatric patients with SSTI, sensitivity and specificity of point-of-care ultrasonography for abscesses were 96 and 87%, respectively, outperforming those of clinical examination (84 and 60%, respectively).[54] In a study of 32 patients with ulcers including diabetic foot infections, swabbing after ultrasonic debridement of the ulcer was equally reliable to biopsy.[55] The use of LRINEC score along with 'a pain out of proportion' and a five-fold increase in C-reactive protein (CRP) levels may increase the diagnostic threshold for necrotizing fasciitis,[56] which remains an important diagnostic challenge in the ED.[57]

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