Soft tissue infections

Abstract

The skin is the largest organ of the body and acts as a structural barrier to invasion by microbes. A myriad of microbes can produce soft tissue infection, and to confound issues, there is considerable overlap of clinical presentation. Most skin and soft tissue infections (SSTI) are caused by S. aureus and beta-hemolytic streptococcus groups A, C, and G. Soft-tissue infections frequently occur in all healthcare settings accounting for approximately 48.5 in 1000 outpatient visits in the United States. Many single-institution studies continue to report mortalities of 8-17%. Non-necrotizing soft-tissue infections include impetigo, folliculitis, simple abscess, erysipelas, cellulitis, and simple and complex abscess. Necrotizing soft tissue infections (NSTI) can affect any soft tissue layer. Signs of systemic toxicity are present in 25-40% with NSTI and include fever, tachycardia, hypotension, and organ dysfunction. Imaging may be useful in cases where the diagnosis is in doubt or in defining the extent of disease. NSTIs are a surgical emergency and the mainstay of treatment is surgical debridement. Test the integrity of the tissue plane between the subcutaneous fat or superficial fascia and the deep fascia with either a finger or clamp to assist with determining extent of debridement. Skin-sparing incisions can facilitate closure of all, or portions of wounds amenable to closure. Hyperbaric oxygen (HBO) is an adjunct to resuscitation, surgical debridement, and broad-spectrum antibiotics. Delays in treatment result in increased mortality and morbidity rates.