Latest updates on bacterial skin and soft tissue infections: Cellulitis, erysipelas, necrotizing fasciitis = Latest updates on bacterial skin and soft tissue infections: Cellulitis, erysipelas, necrotizing fasciitis

다국어 초록 (Multilingual Abstract)

Bacterial skin and soft tissues infections often determine acute disease and frequent emergency recovering, and they are one of the most common causes of infection among groups of different ages. Although specific bacteria may cause a particular type of infection, a considerable overlap in clinical presentations remains. According to the depth of the infection, bacterial skin infections can be classified into superficial infections, involving epidermis and.or dermis, and deep infections, extending from deep dermis to subcutaneous adipose tissue, muscular fascia and muscle. This review discusses about the differences among cellulitis, erysipelas and necrotizing fasciitis and provide a rational diagnostic and therapeutic approach to these infections. 1) Erysipelas : A soft tissue infection involving the upper dermis. When compared with other soft tissue skin infections erysipelas has more distinct margins. Patients with mild infection may be treated with oral penicillin or amoxicillin. Macrolides have also traditionally used but may not be adequate therapy in area with relatively high resistance rates among ß-hemolytic streptococci. Patients with systemic manifestations such as fever or chills, should be treated with parenteral therapy and appropriate choices include ceftriaxone or cefazolin. 2) Cellulitis : A skin infection involving the deeper dermis and subcutaneous fat. Typical cases without systemic signs of infection should be treated with antistreptococcal antimicrobial agents (cephalexin, dicloxacillin, penicillin, amoxicillin/clavulanate, clindamycin) and vancomycin or other agents (linezolid and tedizolid) with activity against both streptococcal and MRSA infections should be used in severe cases of cellulitis. In cases of cellulitis unresponsive to conventional therapy, antibiotic resistance, atypical cases, or pseudocellulitis should be considered. 3) Necrotizing fasciitis : A deep skin infection that results in progressive destruction of the muscle fascia. The affected area may be erythematous, swollen, warm and exquisitely tender. Pain out of proportion to exam findings may be observed. The diagnosis is established surgically with visualization of fascial planes. Management of the infection begins with broad-spectrum antibiotics (ampicillin/surbactam, 3rd or 4th generation cephalosporins, clindamycin, metronidazole, carbapenems), but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment.