2. Defination :
Skin and soft tissue infections encompass a
range of clinical diagnoses from furuncles and
carbuncles to necrotizing fasciitis. They account
for 17% of all clinic visits and most often can be
deal with as an outpatient. As this module
pertains mainly to the inpatient setting, the
discussion below will focus on erysiplelas,
cellulitis, abscess, and necrotizing fasciitis.
3. SSTIs Objectives
To classify types of skin infections.
To present a case of cellulitis and discuss management.
To discuss differences in the management of
community associated versus hospital associated
SSTIs.
To present a case of decubitus ulcer and discuss
management.
To describe management of animal bite wounds.
4. Skin and Soft Tissue Infections Disease
Cellulitis
Impetigo
Erysipelas
Abscess
Animal bite
Human bite
Surgical site infection
Necrotizing fasciitis
7. Treatment of Cellulitis
Penicillins:
Penicillin (group A streptococcus only): orally/IM
Nafcillin (MSSA or streptococcus)
Dicloxacillin orally
Cephaloporins: (1st generation)
Cefazolin IV
Cephalexin/cefprozil orally
Macrolides:
Erythromycin/Azithromycin/Clarithromycin
Clindamycin
Vancomycin IV: PCN allergic
Linezolid IV/PO
8. Impetigo
staphylococcus , streptoccus infection which
presented with honey crust skin after blisters rupture.
Rx : broad spectrum Abcs.
9. Case of Impetigo
Caused by gp A strep (rarely gp B,C and G) and
S.aureus
Disease of children (age 2-5) but can occur in adults
Predisposing factors include warm climate, crowding,
poor hygiene
Treatment of Impetigo:
Penicillin (drug of choice)
PCN-allergic: erythromycin PO x 7 to 10 days
Mupirocin: topical less effective than oral therapy
10. Erysipelas
(localized cellulitis) sharply demarcated streptcoccal
infection of lymphatic vessels, usually associated with
broken skin on face, erythema, Oedema
do --- C/S
Rx : broad spectrum Abcs
11. Case of Erysipelas
Caused by gp A strep (occasionally other gps)
Bimodal distribution -- infants/children and older
adults
Usually face and extremities; abdomen if assoc with
surgery
Painful, raised, erythematous, rapidly spreading lesion
with well demarcated edges
Systemic symptoms common
Therapy same as non-culturable cellulitis
13. Skin Abcess
Is a collection of pus (dead neutrophils) that has
accumulated in a cavity formed by the tissue in which
the pus resides on the basis of an infectious process
(usually caused by bacteria or parasites)
15. Treatment of Animal Bites
• mpicillin/sulbactam
• Piperacillin/tazobactan
• Cefoxitin
• Meropenem
• Ertapenem
Human Bite
16. Treatment of Human Bite
Cefoxitin
Ampicillin/sulbactam
Ertapenem(restricted to ID and Surgery)
17. Surgical Site Infection
Pain, swelling, erythema, purulent drainage
Usually have no clinical manifestations for at least 5
days after operation
Most resolve without antibiotics
Treatment
Cefazolin
Clindamycin
Vancomycin if MRSA is suspected