Skin and skin structure infection

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Skin and skin structure infections (SSSIs), also referred to as skin and soft tissue infections (SSTIs),[1] or acute bacterial skin and skin structure infections (ABSSSIs),[2] are infections of skin and associated soft tissues (such as loose connective tissue and mucous membranes).[citation needed] Historically, the pathogen involved has most frequently been a bacterial species—always, since redescription of SSSIs as ABSSSIs—and as such, these infections require treatment by antibiotics.[citation needed]

Until 2008, a distinction was made between two types: complicated SSSIs (cSSSIs) and uncomplicated SSSIs (uSSSIs),[3] which had different regulatory approval requirements.[4][needs update] Uncomplicated SSSIs included "simple abscesses, impetiginous lesions, furuncles, and cellulitis."[4] Complicated SSSIs included "infections either involving deeper soft tissue or requiring significant surgical intervention, such as infected ulcers, burns, and major abscesses or a significant underlying disease state that complicates the response to treatment."[4] The FDA further noted that "[s]uperficial infections or abscesses in an anatomical site, such as the rectal area, where the risk of anaerobic or Gram-negative pathogen involvement is higher, [were also] considered complicated infections."[4] The uncomplicated category (uSSSI) is most frequently caused by Staphylococcus aureus and Streptococcus pyogenes, whereas the complicated category (cSSSI) might also be caused by a number of other pathogens.[4][verification needed] As of 2013, the pathogen involved in cases of cSSSI were known about 40% of the time.[4][needs update][verification needed]

As of 2014, physicians were reported as generally not culturing to identify the infecting bacterial pathogen during diagnosis of SSSIs; most often treatment is empirical, with choice of an antibiotic agent based on presenting symptoms and location, and further followup based on trial and error.[5][verification needed] To achieve efficacy against SSSIs, physicians most often use broad-spectrum antibiotics,[citation needed] a practice contributing to increasing prevalence of antibiotic resistance,[citation needed] a trend related to the widespread use of antibiotics in medicine in general.[citation needed] The increased prevalence of antibiotic resistance is evident in MRSA species commonly involved in SSSIs, which worsen prognoses and limit treatment options.[citation needed] For less severe infections, microbiologic evaluation using tissue culture has been demonstrated to have high utility in guiding management decisions.[5]

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  1. ^ SSTI is the preferred description of the Infectious Diseases Society of America (IDSA), see Stevens, D. L.; Bisno, A. L.; Chambers, H. F.; Dellinger, E. P.; Goldstein, E. J. C.; Gorbach, S. L.; Hirschmann, J. V.; Kaplan, S. L.; Montoya, J. G.; Wade, J. C. (18 June 2014). "Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 59 (2): e10–e52. doi:10.1093/cid/ciu296. PMID 24947530.
  2. ^ The U.S. Food and Drug Administration began referring to this category of infection as acute bacterial SSSIs (ABSSSI) in 2008. See "Guidance for Industry Acute Bacterial Skin and Skin Structure Infections: Developing Drugs for Treatment" (PDF). Aug 2010.
  3. ^ Rosen, T (2005). "Update on treating uncomplicated skin and skin structure infections". Journal of Drugs in Dermatology. 4 (6 Suppl): s9–14. PMID 16300224.
  4. ^ a b c d e f "Guidance for Industry - Acute Bacterial Skin and Skin Structure Infections: Developing Drugs for Treatment" (PDF). Food and Drug Administration. October 2013. Retrieved 2014-11-23.
  5. ^ a b Xia, Fan Di; Song, Philip; Joyce, Cara; Mostaghimi, Arash (2017). "The Utility of Microbiological Studies in Diagnosis and Management of Suspected Dermatological Infection". JAMA Dermatology. doi:10.1001/jamadermatol.2017.3057. PMC 5817467.

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