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Morning Report
Karen Estrella-Ramadan
COMPLICATED SKIN AND SKIN
STRUCTURE INFECTIONS
The primary challenge in managing skin
and soft-tissue infections is to avoid
delays in diagnosis and thereby prevent
uncomplicated infections from
progressing.
 Including: hospitalization, prompt initiation
of antimicrobial therapy, or surgical
consultation.

FDA: Center for Drug Evaluation and
Research criteria
CSSI’s
1.
Involvement of deep tissues, including subcutaneous fat
2.
Need for significant surgical intervention
3.
Involvement of the perianal area
4.
Infection of the foot in a diabetic patient
5.
Presence of significant coexisting diseases, including diabetes
mellitus, an immunocompromised state, and obesity.
ABSSi’s
1.
wound infections, major cutaneous abscesses, infected burns
accompanied by redness, edema, and/or induration of a minimum
surface area of 75 sq cm (15x5cm or at least 5cm outside
margins peripheral area of wound), accompanied by lymph node
enlargement or systemic symptoms such as fever 38C (100.4- F)
or greater
As a review…

Uncomplicated skin infections:
◦ Impetigo, erysipelas, folliculitis, furunculosis,
and, in some cases, superficial cellulitis

Complicated:
◦ Cellulitis:
 necrotizing fasciitis
 Septic arthritis, and
osteomyelitis, often will have
overlying cellulitis
◦ Lymphangitis
◦ Carbuncles
Only 5% will have blood cx (+)
Etiology
Necrotizing fascitis:
S pyogenes +
aerobic, anerobic,
facultative organism
15% will not have an
identicable cause
SX wounds:
S pyogenes and
Clostridium perfringens
can lead to infection
within 48 hours of
operation.
Management
•pain that is disproportionate to
physical findings
• blisters, ecchymosis, bullae, or
crepitus
•Rapid progression
Pus
When to send them to OR
http://jac.oxfordjournals.org/content/53/suppl_2/ii37.full.pdf+html
Antibiotics

Skin and soft tissue skin infections…
◦ please see table on page 4
IDSA
References

University School of medicine, Cleveland OH
◦ http://www.ccjm.org/content/74/Suppl_4/S21.full.pdf

John Hopkins, Upenn guidelines
◦ http://cid.oxfordjournals.org/content/41/10/1373.full.pdf+html

FDA-guidelines
◦ http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegul
atoryInformation/Guidances/UCM071185.pdf
http://journals.lww.com/aswcjournal/Fulltext/2012/03000/Co
mplicated_Skin_and_Skin_Structure_Infections__A.1.aspx#
 Clinical presentation:

◦ http://cid.oxfordjournals.org/content/33/Supplement_2/S84.full.p
df+html