Treatment of Skin and Soft Tissue Infections

Abstract

Bacterial infections of the skin, which often extend to involve adjacent soft tissue, have been classified as primary pyodermas, infectious gangrene and gangrenous cellulitis, and secondary bacterial infections complicating preexisting skin lesions. The major pathogens causing primary skin infection and soft tissue infection among immunocompetent patients, in the absence of unique epidemiologic considerations, are Staphylococcus aureus and beta-hemolytic streptococci, particularly Streptococcus pyogenes. Surveillance programs (SENTRY Antimicrobial Surveillance Program) that have examined the microbiology of nosocomial or community-acquired skin and soft tissue infections occurring in hospitalized patients also indicate differences in the causes of the infections compared with those associated with the primary pyodermas. Polymicrobial infections in the feet of patients with diabetes mellitus (so called diabetic foot infection) usually arise from neuropathic ulcers and frequently occur in the setting of arterial insufficiency. Although patients with these infections are often included in treatment trials for complicated skin and soft tissue infections, because of the uniqueness of the clinical setting and the frequency of this problem some studies have focused solely on fluoroquinolone treatment of this entity. Data from comparative and noncomparative clinical trials demonstrate that currently available fluoroquinolones are highly effective treatment for mild, uncomplicated as well as for more severe, complicated skin and soft tissue infections. If fluoroquinolones are to be used in these patients, a second drug with predictable anti-anaerobic activity should be included in the regimen. Similarly, fluoroquinolones should be used with caution when infections are known or likely to be caused by methicillin-resistant S. aureus.