Types of Skin & Soft Tissue Infections

Mon, 04/13/2020 - 5:00am
Author: 
Courtney Martin, DO
Editor: 
Alison Jaworski, MD

Soft Tissue Infections

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Minor:

▪ Folliculitis- pustules with surrounding erythema at site of hair follicles

          • Typical pathogens: Staph aureus or Pseudomonas

▪ Erisipelas- Superficial infection including only the epidermis, well demarcated area of warmth and erythema

          • Typical pathogens: beta hemolytic strep

▪ Cellulitis- Deep infection including dermis

          • Typical Pathogens: beta hemolytic strep or MSSA

▪ Abscess- collection of pus within the dermis or subcutaneous space

          • Typical pathogens: MSSA or MRSA

 

o Typical Antibiotics: 

  ▪ Beta Hemolytic Strep- Keflex or Clindamycin

  ▪ Staph Aureus- Bactrim, Clindamycin, or Doxycycline

  ▪ Pseudomonas- Ciprofloxacin, Ampicillin, or Bactrim

 

Major:

▪ Necrotizing Fasciitis: infection of the deep soft tissues, spreads through the fascial layer

     • Typical pathogens: 

  •      •  Type 1: Polymicrobial- typically anaerobe plus Enterobacteriaceae andanaerobic streptococci

  •      •  Type 2: Monomicrobial- Group A strep or MRSA

  •      •  Type 3: Vibrio Species

  • o Treatment:

  •      •  Emergency surgery!

  •      •  Zosyn + Vancomycin + Clindamycin

  •               Note- Clindamycin is given for its anti-toxin effects in staph and strep infections

     

Toxic Shock Syndromes

  • Staph Toxic Shock Syndrome: Staph Aureus

          - Toxin- exotoxin (TSST-1), superantigen

          - Causes: 50% tampon use, 50% surgical/post-partum infections, osteomyelitis, mastitis, burns, etc
          - Treatment: Vancomycin plus Clindamycin
 
  • Strep Toxic Shock Syndrome: Group A strep

          - Toxin- exotoxins A and B, superantigens

          - Typically associated with necrotizing fasciitis or myositis
          - Increased mortality than staph toxic shock syndrome
          - Treatment: Zosyn or Carbapenam plus Clindamycin

 

 

Resources:

Chu, V. H. (2019, October 1). Staphylococcal toxic shock syndrome. Retrieved April 10, 2020, from https://www.uptodate.com/contents/staphylococcal-toxic-shock-syndrome?se... toxic shock&source=search_result&selectedTitle=1~42&usage_type=default&display_rank=1

Jackson, J. D. (2019, August 30). Infectious folliculitis. Retrieved April 10, 2020, from https://www.uptodate.com/contents/infectious- folliculitis?search=folliculitis&source=search_result&selectedTitle=1~150&usage_type=default &display_rank=1#H19981454

Spelman, D., & Baddour, L. M. (2019, April 1). Cellulitis and skin abscess in adults: Treatment. Retrieved April 10, 2020, from https://www.uptodate.com/contents/cellulitis-and-skin-abscess- in-adults-treatment?search=soft tissue infection&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Stevens, D. L. (2019, March 5). Invasive group A streptococcal infection and toxic shock syndrome: Epidemiology, clinical manifestations, and diagnosis. Retrieved April 10, 2020, from https://www.uptodate.com/contents/invasive-group-a-streptococcal-infecti... shock-syndrome-epidemiology-clinical-manifestations-and- diagnosis?search=abscess&topicRef=110529&source=see_link#H28998789

Stevens, D. L., & Baddour, L. M. (2020, February 28). Necrotizing soft tissue infections. Retrieved April 10, 2020, from https://www.uptodate.com/contents/necrotizing-soft-tissue- infections?search=abscess&topicRef=110529&source=see_link#H22