Acute Soft Tissue and Bone Infections

Abstract

Skin and soft tissue infections (SSTIs), acute bacterial skin and skin structure infections (ABSSSI), acute bacterial skin and skin structure infections (ABSSSI), and bone infections (osteomyelitis) may complicate acute management of orthopedic injuries. SSTIs range from superficial surgical site infection after fracture repair to severe infections, including necrotizing soft tissue infections and acute/chronic osteomyelitis. Knowledge of common causative bacterial pathogens and appropriate antimicrobial therapy is necessary in the care of these patients. There are four fundamental management principles that are key to a successful outcome in caring for patients with severe SSTIs, including (1) early diagnosis and differentiation of necrotizing vs. non-necrotizing SSTI, (2) early initiation of appropriate empiric broad-spectrum antimicrobial therapy with consideration of risk factors for specific pathogens, (3) “source control,” that is, early aggressive surgical intervention for drainage of abscesses and debridement of necrotizing soft tissue infections, and (4) pathogen identification and appropriate de-escalation of antimicrobial therapy. MRSA has emerged as the most common identifiable cause of severe SSTIs, therefore initiation of empiric anti-MRSA antimicrobials is warranted in all cases of severe SSTIs and osteomyelitis.