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Semin Respir Crit Care Med 2022; 43(01): 003-009
DOI: 10.1055/s-0041-1740974
Review Article

Severe Skin and Soft-Tissue Infections

Addison E. Stieferman
1   Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
,
Patrick Mazi
2   Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
,
Jason P. Burnham
2   Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations Funding None.
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Abstract

Skin and soft-tissue infections (SSTIs) are a common reason for hospital admission. Severe SSTIs, particularly necrotizing infections, often require intensive care. Source control (often with surgical debridement) and broad-spectrum antimicrobials are paramount for minimizing significant morbidity and mortality. Rapid diagnostic tests may help in selection and de-escalation of antimicrobials for SSTIs. Besides early source control and early effective antimicrobial therapy, other patient-level factors such as comorbidities and immune status play a role in clinical outcomes. Intravenous immunoglobulin continues to be studied for severe SSTI, though recruitment in trials continues to be an issue. Severe SSTIs are complex to manage, due in part to regional variation in predominant pathogens and antimicrobial resistance patterns, as well as variations in host immune responses. This review includes descriptions of source control, antimicrobial therapies, intravenous immunoglobulin, and hyperbaric oxygen therapy, as well as host factors in severe SSTIs.

Keywords

soft-tissue infections - necrotizing fasciitis - gas gangrene


Publication History

Article published online:
16 February 2022

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