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skin infection

Includes infections of skin appendages. - see skin & soft tissue infection for differential diagnosis & management Etiology: - Staphylococcus aureus including MRSA - beta-hemolytic Streptococcus - bacterial skin pathogens - viral infections Epidemiology: - most serious infections are healthcare associated [1] Pathology: - superficial & soft tissue bacterial infection results in cellulitis - deeper bacterial infection results in abscess formation - when the fascia is involved, necrotizing fasciitis may occur - involvement of hair follicles results in folliculitis Laboratory: - gram stain & culture of purulent drainage if systemic symptoms - see ARUP consult [2] Radiology: - radiography only when - diagnosis uncertain - necrotizing fasciitis suspected - abscess or foreign body suspected [12] Management: - see specific skin infection - once weekly dalbavancin* may be an option [8,13] - single-dose oritavancin* may be an option [8] - cephalexin or dicloxacillin first-line empirical treatment - clinidamycin & trimethoprim/sulfamethaxazole have similar efficacy for treatment of uncomplicated skin infection [11] * effective against MRSA * see ref [9] for detailed 2014 guidelines

Related

skin & soft tissue infection

Specific

carbuncle (carbunculosis) cellulitis cutaneous tuberculosis; includes tuberculous chancre, tuberculosis verrucosa cutis dermatophilosis (mud fever) donovanosis (granuloma inguinale, granuloma venereum) eczema herpeticum erythrasma folliculitis furuncle impetigo mucocutaneous infection omphalitis pitted keratolysis scabies

General

skin disease (dermatologic disorder, dermatopathy, dermatosis) infection (infectious disease)

References

  1. Zilberberg MD et al Epidemiology and outcomes of hospitalizations with complicated skin and skin-structure infections: Implications of healthcare- associated infection risk factors. Infect Control Hosp Epidemiol 2009 Dec; 30:1203. PMID: 19848604
  2. ARUP Consult: Necrotizing Soft Tissue Infections - Complicated Skin Infections The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/necrotizing-soft-tissue-infections
  3. Stevens DL, Bisno AL, Chambers HF, Everett ED Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005 Nov 15;41(10):1373-406. Epub 2005 Oct 14 PMID: 16231249
  4. Noah S. A primer on topical antibiotics for the skin and eyes. J Drugs Dermatol. 2008 Apr;7(4):409-15. PMID: 18459527
  5. Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002 Jul 1;66(1):119-24. PMID: 12126026
  6. Hurley HJ et al. Avoidable antibiotic exposure for uncomplicated skin and soft tissue infections in the ambulatory care setting. Am J Med 2013 Dec; 126:1099 PMID: 24262724 http://www.amjmed.com/article/S0002-9343(13)00769-9/abstract
  7. Kish TD1, Chang MH, Fung HB. Treatment of skin and soft tissue infections in the elderly: A review. Am J Geriatr Pharmacother. 2010 Dec;8(6):485-513 PMID: 21356502
  8. Boucher HW et al. Once-weekly dalbavancin versus daily conventional therapy for skin infection. N Engl J Med 2014 Jun 5; 370:2169 PMID: 24897082 http://www.nejm.org/doi/full/10.1056/NEJMoa1310480 - Corey GR et al. Single-dose oritavancin in the treatment of acute bacterial skin infections. N Engl J Med 2014 Jun 5; 370:2180. PMID: 24897083 http://www.nejm.org/doi/full/10.1056/NEJMoa1310422 - Chambers HF. Pharmacology and treatment of complicated skin and skin- structure infections. N Engl J Med 2014 Jun 5; 370:2238. PMID: 24897088 http://www.nejm.org/doi/full/10.1056/NEJMe1405078
  9. Stevens DL et al Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis. June 18, 2014 PMID: 24947530 Free full text http://cid.oxfordjournals.org/content/early/2014/06/14/cid.ciu296.full - Stevens DL, Bisno AL, Chambers HF et al Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52. Erratum in: Clin Infect Dis. 2015 May 1;60(9):1448. Dosage error in article text. PMID: 24973422 Free Article
  10. Prescriber's Letter 21(8): 2014 CHART: Antibiotics for MRSA Skin Infections CHART: Drug Treatment of Skin and Soft Tissue Infections GUIDELINES: Executive Summary: Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America Detail-Document#: 300823 (subscription needed) http://www.prescribersletter.com
  11. Miller LG et al Clindamycin versus Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Infections. N Engl J Med 2015; 372:1093-1103. March 19, 2015 PMID: 25785967 http://www.nejm.org/doi/full/10.1056/NEJMoa1403789 - Wessels MR. Choosing an antibiotic for skin infections. N Engl J Med 2015 Mar 19; 372:1164 PMID: 25785974 http://www.nejm.org/doi/full/10.1056/NEJMe1500331
  12. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  13. Walker M. Dalbavancin Protocol in ED Effective for Skin Infections. Use of long-acting IV lipoglycopeptide antibiotic also cut hospital admissions. MedPage Today. June 10, 2018 https://www.medpagetoday.com/meetingcoverage/asmmicrobe/73402 - Dubrovskaya Y et al Collaborative interdisciplinary process for dalbavancin (DBV) use in emergency department as an alternative to hosp. admission. ASM Microbe 2018; Abstract Saturday 588.
  14. Kamath RS, Sudhakar D, Gardner JG et al Guidelines vs actual management of skin and soft tissue infections in the emergency department. Open Forum Infect Dis. 2018;5:ofx188. PMID: 29354655 Free PMC Article
  15. Ramdass P, Mullick S, Farber HF. Viral Skin Diseases. Prim Care. 2015 Dec;42(4):517-67. dReview. PMID: 26612372
  16. Elkston CA, Elkston DM Bacterial Skin Infections: More Than Skin Deep. Medscape. July 19, 2021 https://reference.medscape.com/slideshow/infect-skin-6003449
  17. Winsett FT, Patel SG, Kelly BC. Bedside diagnostics for infections: a guide for dermatologists. Am J Clin Dermatol. 2020;21:697-709. PMID: 32562204
  18. Silverberg B. A Structured Approach to Skin and Soft Tissue Infections (SSTIs) in an Ambulatory Setting. Clin Pract. 2021 Feb 1;11(1):65-74. PMID: 33535501 PMCID: PMC7931029 Free PMC article. Review.