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Skin & Soft Tissue

InfectionBy: dr ismah

Ortho department

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Anatomy

hospitals.unm.edu

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Epidemiology • Skin and soft-tissue infections (SSTIs) are a

common reason for presentation to outpatient practices, emergency rooms, and hospitals

• They account for more than 14 million outpatient visits in the United States each year and visits to the emergency room and admissions to the hospital for them are increasing

• Hospital admissions for SSTIs increased by 29% from 2000 to 2004

Edelsberg J, Taneja C, Zervos M, et al. Trends in US hospital admissionsfor skin and soft tissue infections. Emerg Infect Dis 2009; 15:1516–1518.

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Erysipelas

Cellulitis

NF

Cleveland Clinic Journal of Medicine-2012-RAJAN-57-66

Gas gangrene

6Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections:

2014 Update by the Infectious Diseases Society of America

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Thank you

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Cellulitis • Often caused by Group A β - haemolytic streptococci,

(Streptococcus pyogenes)

• The infected area is painful, hot and oedematous

• Non-raised skin lesions with indistinct margin, sometimes with lymphangitis

• There is usually no localization of the infection or pus formation

• May associate with insect bites, trauma or ill fitting shoes

• IV C Pen 2.4 Mu, IV Cloxacillin. Dressing with CHD cream

Cleveland Clinic Journal of Medicine-2012-RAJAN-57-66

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INDICATIONS FOR ADMISSION:-

• Severe or rapidly worsening infection

• Patient systemically unwell

• Uncertainty regarding the diagnosis (need to out rule DVT)

• Immunocompromised patient. Diabetes mellitus – if unstable

• Children under one year of age or elderly without goodhome support

• Lack of response to home treatment at 48 hoursJohnny Loughnane

Irish College of General Practitioners April 2006

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Cellulitis

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Necrotizing fascitis• An aggressive subcutaneous infection that tracks

along the superficial fascia, which comprises all the tissues between the skin and underlying muscles

• Rapid progression

• Physical exam Skin bullae Ischemic patches Swelling, edema Crepitus

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America

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• Features that suggest involvement of deeper tissues include

(1) severe pain that seems disproportional to the clinical findings; (2) failure to respond to initial antibiotic therapy;(3) the hard, wooden feel of the subcutaneous tissue, extending beyond the area of apparent skin involvement; (4) systemic toxicity, often with altered mental status; (5) edema or tenderness extending beyond the cutaneous erythema; (6) crepitus, indicating gas in the tissues; (7) bullous lesions;(8) skin necrosis or ecchymoses

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America

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Anaya DA, Dellinger EP. Necrotizing soft-tissue infection :

diagnosis and management. ClinInfect Dis 2007; 44:705–710,

Oxford University Press.

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Treatment • Surgical debridement• Antibiotic

Type 1 Type 2

Polymicrobial infection. Immunocompromised.

Group A strep

Cloxacillin 2g IV q4-6hPLUSMetronidazole 500mg IV q8hPLUSGentamicin1 5mg/kg IV q24h

Benzylpenicillin 2-4 mega units IV q4hPLUSClindamycin 600mg IV q8h

ALTERNATIVES:3rd gen. CephalosporinsPLUSMetronidazole 500mg IV q8hORβ-lactam/β-lactamase inhibitors, e.g.Ampicillin/Sulbactam 1.5g IV q8hORAmoxycillin/Clavulanate 1.2g IV q8hPLUS/MINUSGentamicin1 5mg/kg IV q24h

National_Antibiotic_Guideline_2008

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Gas gangrene• Clostridium perfringens

• Gram-positive obligate anaerobic spore-forming rods that produce exotoxins 

• Causes muscle necrosis and vessel thrombosis, hemolysis and shock

• Rx : Benzylpenicillin 2-4 mega units IV q4h PLUS Metronidazole 500mg IV q8h PLUS/MINUS Gentamicin1 5mg/kg IV q24h

18University of Kansas Medical Center- http://www.kumc.edu/

swelling, edema, discoloration and ecchymosis, blebs and hemorrhagic bullae