Загальні відомості про бактеріальні інфекції шкіри

Bacterial skin infections can be classified as skin and soft-tissue infections (SSTI) and acute bacterial skin and skin structure infections (ABSSSI).

SSTI include  

• Carbuncles

• Ecthyma

• Erythrasma

• Folliculitis

• Furuncles

• Impetigo

• Lymphadenitis

• Minor cutaneous abscesses

ABSSSI are complex bacterial skin infections. They include

• Cellulitis

• Erysipelas

• Lymphangitis

• Major cutaneous abscesses (> 75 cm² including edema, erythema, and induration)

• Necrotizing soft-tissue infection

• Wound infections

Staphylococcal scalded skin syndrome, scarlet fever, and toxic shock syndrome are skin-related consequences of bacterial infections.

The primary pathogens in SSTI are Streptococcus and Staphylococcus species, including methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a common pathogen in the United States. However, the proportion of cases attributed to MRSA differs substantially elsewhere in the world. Because MRSA can be resistant to multiple antibiotics, recommended antibiotics for bacterial skin and soft-tissue infections depend largely on local prevalence and resistance patterns of MRSA.

The Infectious Diseases Society of America's (IDSA) 2014 guidelines for the diagnosis and management of skin and soft-tissue infections recommend that mild to moderate nonpurulent ABSSSI be treated with a beta-lactam or clindamycin as presumptive coverage for streptococci. Coverage for MRSA should be considered as well in patients at risk (eg, after penetrating trauma, with suspected nasal MRSA carriage, or who use illicit IV drugs). Purulent ABSSSI are considered severe if patients have signs of systemic toxicity (eg, fever, tachycardia, tachypnea, delirium, leukocytosis). If so, Gram stain, culture, and antibiotic therapy are recommended. The antibiotic of choice is usually vancomycin. However, several alternatives are available.