New treatment guidelines for skin infections

Although skin and soft tissue infections (SSTIs) can be deadly, most heal by themselves without antibiotics, say new practice guidelines from the Infectious Diseases Society of America (ISDA). The trick is knowing when, and when not to use the drugs.

To that end, the new guidelines, updating 2005 guidelines, provide treatment advice on a wide range of SSTIs from minor to life threatening, including the use of newer antimicrobials to treat drug-resistant organisms. They are designed to mesh with the IDSA’s 2011 practice guidelines for treating methicillin-resistant Staphylococcus aureus (MRSA) infections.

The new recommendations emphasize that diagnosing and treating SSTIs promptly relies primarily on clinical skills and experience because it’s often difficult or impossible to identify the causative pathogen quickly. They offer 2 algorithms: 1 for managing purulent and nonpurulent SSTIs and 1 for treating surgical site infections.

Most purulent infections, accounting for approximately half of SSTIs, are mild and respond to incision and drainage alone. These infections are caused by staphylococcus bacteria, including MRSA, as opposed to more serious nonpurulent infections caused by bacteria such as group A Streptococcus, which produce toxins that can be life threatening. Moderate and severe purulent infections, with signs of systemic infection, and nonpurulent infections require antibiotics.

The algorithm for surgical site infections distinguishes between situations in which fever begins within 48 hours to 4 days after surgery and cases in which fever begins longer than 4 days after surgery. Later starting fevers are more complicated to treat.

The new guidelines also address SSTIs in immunocompromised patients, whose numbers are growing worldwide and who are more susceptible to severe infection.

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