Skin and Soft Tissue Infections

Abstract: Skin and soft tissue infections (SSTIs) are among the most commonly occurring bacterial infections. Many factors contribute to the increase in terms of awareness for SSTIs: the aging of the general population, the growing number of critically ill or immunocompromised patients, and the emergence of multidrug-resistant (MDR) pathogens are commonly considered the main reasons for their increase in frequency and severity. On this basis, the Infectious Diseases Society of America (IDSA) classification has been the most useful and practical guidance to date by adopting three different distinctions: (1) skin extension: uncomplicated typically superficial infections (uSSTI) and complicated infections (cSSTIs), usually with deep involvement; (ii) rate of progression: acute and chronic wound infections; and (iii) tissue necrosis: necrotizing and non-necrotizing infections. Staphylococci sustain the majority of cases with skin abscesses, and the bacteria that constitute the normal skin flora boost their virulence. Diagnostic workup of SSTI is different with respect to patient condition and infection severity. Blood cultures have to be attempted for cases with severe infection requiring hospitalization. Cultures and microscopic examination of cutaneous aspirates, pus, biopsies, or swabs should be considered in complex infection, septic and immunosuppressed patients, water- or soil-related injuries, and animal bites. In general, superficial infections would need just oral antibiotic treatments or even topical treatments. Deeper infections should be considered for their severity before treatment choice, taking into consideration the skin extension, the rate of progression, and finally the necrotizing or non-necrotizing characteristics of the infection.