Skin and skin structure infections (
SSSIs), also referred to as
skin and soft tissue infections (
SSTIs),
[SSTI is the preferred description of the Infectious Diseases Society of America (IDSA), see ] or
acute bacterial skin and skin structure infections (
ABSSSIs),
[The U.S. Food and Drug Administration began referring to this category of infection as acute bacterial SSSIs (ABSSSI) in 2008. See ] are
of
skin and associated
(such as loose connective tissue and
). Historically, the
pathogen involved has most frequently been a
species—always, since redescription of SSSIs as ABSSSIs—and as such, these infections require treatment by
antibiotics.
Types
Until 2008, a distinction was made between two types: complicated SSSIs (cSSSIs) and uncomplicated SSSIs (uSSSIs),
which had different regulatory approval requirements.
Uncomplicated SSSIs included "simple
,
impetigo,
, and
cellulitis."
[ 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."][ The FDA further noted that "superficial 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 considered complicated infections."][ 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.][ As of 2013, the pathogen involved in cases of cSSSI were known about 40% of the time.][
]
Diagnosis
As of 2014, physicians were reported as generally not culturing to identify the infecting bacterial pathogen during diagnosis of SSSIs
Treatment
Common treatment is empiric therapy, with choice of an antibiotic agent based on presenting symptoms and location, and further followup based on trial and error. To achieve efficacy against SSSIs, physicians most often use broad-spectrum antibiotics, a practice contributing to increasing prevalence of antibiotic resistance, a trend related to the widespread use of antibiotics in medicine in general. The increased prevalence of antibiotic resistance is evident in MRSA species commonly involved in SSSIs, which worsen prognoses and limit treatment options. For less severe infections, microbiologic evaluation using tissue culture has been demonstrated to have high utility in guiding management decisions.
There is no evidence to support or oppose the use of Chinese herbal medicines in treating SSTIs.
See also
Further reading