Severe Soft Tissue Infections

被引:46
作者
Napolitano, Lena M. [1 ]
机构
[1] Univ Michigan Hlth Syst, Div Acute Care Surg, Dept Surg, Ann Arbor, MI 48109 USA
关键词
Skin infections; Soft tissue infections; Necrotizing soft tissue infections; Abscess; Drainage; Debridement; Methicillin-resistant S aureus; Antimicrobial therapy; RESISTANT STAPHYLOCOCCUS-AUREUS; SKIN-STRUCTURE INFECTIONS; DISTINGUISHING NECROTIZING FASCIITIS; LABORATORY RISK INDICATOR; TOXIC-SHOCK-SYNDROME; COMPLICATED SKIN; HYPERBARIC-OXYGEN; VIBRIO-VULNIFICUS; DOUBLE-BLIND; ANTIMICROBIAL TREATMENT;
D O I
10.1016/j.idc.2009.04.006
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Severe skin and soft tissue infections (SSTIs) frequently require management in the ICU, in part related to associated septic shock or toxic shock syndrome or associated organ failure. Four fundamental management principles are key to a successful outcome in caring for patients who have severe SSTIs, including (1) early diagnosis and differentiation of necrotizing versus nonnecrotizing SSTI, (2) early initiation of appropriate empiric broad-spectrum antimicrobial therapy with consideration of risk factors for specific pathogens and mandatory coverage for methicillin-resistant Staphylococcus aureus (MRSA), (3) source control (ie, early aggressive surgical intervention for drainage of abscesses and debridement of necrotizing soft tissue infections), and (4) pathogen identification and appropriate de-escalation of antimicrobial therapy. MRSA has emerged as the most common identifiable cause of severe SSTIs; therefore, initiation of empiric anti-MRSA antimicrobials is warranted in all cases of severe SSTIs. In addition, appropriate critical care management - including fluid resuscitation, organ support and nutritional support - is a necessary component in treating severe SSTIs.
引用
收藏
页码:571 / +
页数:22
相关论文
共 101 条
  • [1] Methicillin-resistant Staphylococcus aureus in two child care centers
    Adcock, PM
    Pastor, P
    Medley, F
    Patterson, JE
    Murphy, TV
    [J]. JOURNAL OF INFECTIOUS DISEASES, 1998, 178 (02) : 577 - 580
  • [2] Meticillin-resistant Staphylococcus aureus among US prisoners and military personnel:: review and recommendations for future studies
    Aiello, AE
    D Lowy, F
    Wright, LN
    Larson, EL
    [J]. LANCET INFECTIOUS DISEASES, 2006, 6 (06) : 335 - 341
  • [3] Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit
    AlvarezLerma, F
    Pellus, AM
    Sanchez, BA
    Ortiz, EP
    Jorda, R
    Barcenilla, F
    Maravi, E
    Galvan, B
    Palomar, M
    Serra, J
    Bermejo, B
    Mateu, A
    Quintana, E
    Palacios, MS
    Giral, R
    Gonzalez, V
    Lerma, FA
    Mesa, JL
    Melgarejo, JA
    Martinez, J
    Insausti, J
    Olaechea, P
    Chanovas, M
    Gilabert, A
    Junquera, C
    Valles, J
    Palacios, F
    Calvo, R
    Mesalles, E
    Nava, J
    Santos, A
    Armengol, S
    Marzo, D
    [J]. INTENSIVE CARE MEDICINE, 1996, 22 (05) : 387 - 394
  • [4] Predictors of mortality and limb loss in necrotizing soft tissue infections
    Anaya, DA
    McMahon, K
    Nathens, AB
    Sullivan, SR
    Foy, H
    Bulger, E
    [J]. ARCHIVES OF SURGERY, 2005, 140 (02) : 151 - 157
  • [5] Necrotizing soft-tissue infection: Diagnosis and management
    Anaya, Daniel A.
    Dellinger, E. Patchen
    [J]. CLINICAL INFECTIOUS DISEASES, 2007, 44 (05) : 705 - 710
  • [6] [Anonymous], 48 INT C ANT AG CHEM
  • [7] [Anonymous], 2002, COCHRANE DB SYST REV, DOI DOI 10.1002/14651858
  • [8] The safety and efficacy of daptomycin for the treatment of complicated skin and skin-structure infections
    Arbeit, RD
    Maki, D
    Tally, FP
    Campanaro, E
    Eisenstein, BI
    [J]. CLINICAL INFECTIOUS DISEASES, 2004, 38 (12) : 1673 - 1681
  • [9] Increasing incidence of methicillin-resistant Staphylococcus aureus skin and soft-tissue infections:: Reconsideration of empiric antimicrobial therapy
    Awad, Samir S.
    Elhabash, Saleem I.
    Lee, Liz
    Farrow, Buckmister
    Berger, David H.
    [J]. AMERICAN JOURNAL OF SURGERY, 2007, 194 (05) : 606 - 610
  • [10] Microbiology and management of myositis
    Brook, I
    [J]. INTERNATIONAL ORTHOPAEDICS, 2004, 28 (05) : 257 - 260