Management of Skin and Soft Tissue Infections

Purulent skin and soft tissue infections (SSTIs). 

• Mild infection: for purulent SSTI, incision and drainage is indicated. 
• Moderate infection: patients with purulent infection with systemic signs of infection. 
• Severe infection: patients who have failed incision and drainage plus oral antibiotics or those with systemic signs of infection such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/μL), or immunocompromised patients. 

Nonpurulent SSTIs. 

• Mild infection: typical cellulitis/ erysipelas with no focus of purulence. 
• Moderate infection: typical cellulitis/erysipelas with systemic signs of infection. 
• Severe infection: patients who have failed oral antibiotic treatment or those with systemic signs of infection (as defined above under purulent infection), or those who are immunocompromised, or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction. 

Algorithm for the management and treatment of surgical site infections (SSIs). 

*For patients with type 1 (anaphylaxis or hives) allergy to β-lactam antibiotics. 

If Gram stain not available, open and debride if purulent drainage present. 

Where the rate of infection with methicillin-resistant Staphylococcus aureus infection is high, consider vancomycin, daptomycin, or linezolid, pending results of culture and susceptibility tests. 

 

 

References:

1. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014  Update by the Infectious Diseases Society of America.