Rapidly progressive skin & soft tissue infections

[Clin Infect Dis 2014;59:e10-52]

Jump to Therapy

Predisposing factors

• trauma/surgery

• immunosuppression/malignancy

• diabetes

• chronic renal/hepatic disease

• chicken pox

• IVDU

Clinical Findings

Early:

• pain out of proportion to appearance

• edema or tenderness beyond the cutaneous erythema

• cellulitis

• fever

• tachycardia

• induration (hard, wooden feel of subcutaneous tissue)

• areas of anaesthesia in affected skin

Late:

• severe pain

• skin discoloration/necrosis (purple or black)

• blistering

• hemorrhagic bullae

• crepitus

• "dishwater" gray drainage

• systemic inflammatory response syndrome (SIRS)/sepsis

• multi-organ failure/shock

Management

- Surgical debridement and irrigation are essential. Send specimens for culture. For culture-directed therapy, see Culture-Directed Infections: Skin & Soft Tissue.

- Infectious Diseases consult strongly recommended.

- Duration of therapy (IV/PO) dependent on clinical picture.

Rapidly progressive skin & soft tissue infections

- On initial presentation it may be difficult to determine etiologic agent(s).

S. pyogenes (Group A Strep)
Mixed aerobic/anaerobic organisms
S. agalactiae (Group B Strep)
Group C,G Strep
S. pneumoniae
S. aureus/MRSA
Clostridium spp
Vibrio vulnificus (salt water exposure)
Aeromonas hydrophila (fresh water exposure)
Enterobacterales (chronic hepatic/renal disease)
P. aeruginosa (neutropenia, burns, IVDU)

Polymicrobial or MRSA suspected

Penicillin allergy