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DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy:
A Pathophysiologic Approach. 8th edition. http://accesspharmacy.com/content.aspx?aid=8002378.
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- Acute, spreading, infectious process that initially affects
epidermis and dermis; may subsequently spread within superficial
- Process characterized by inflammation but
with little or no necrosis or suppuration of soft tissue.
- Most often caused by S. pyogenes or S. aureus.
- Increased incidence of methicillin-resistant S. aureus (MRSA) of major concern.
- Mixed aerobic and anaerobic pathogens seen:
- Following traumatic injuries
- At sites of abdomen or perineum surgical incisions
- With compromised host defenses (e.g., vascular insufficiency)
- Spreading inflammatory infection following wound from
minor trauma, abrasion, ulcer, or surgery.
- Considered a serious infection due to propensity to spread
through lymphatic tissue and to bloodstream.
- 10% of all infection-related hospital admissions
between 1998 and 2006
- Injection drug use
- History of antecedent wound from minor trauma, abrasion, ulcer,
- Poor nutrition
- Characterized by erythema and edema of the skin.
- Erythema and edema of skin; affected areas warm to touch
- Lesions nonelevated, with poorly defined margins
- Inflammation present, with little or no necrosis or suppuration
of soft tissue
- Tender lymphadenopathy
Means of Confirmation
- Diagnosis usually based on appearance of lesion.
- Complete blood count (CBC): leukocytosis common.
- Cultures of affected area may be difficult.
- Gram stain of fluid obtained by injection and aspiration of
- Blood cultures: bacteremia present in as many as 30% of
- Injection and aspiration of 0.5 mL saline into advancing
edge of lesion may aid microbiologic diagnosis, but is often negative.
- Rapid eradication of infection
- Prevention of complications
- Selection of antimicrobial therapy directed toward type
of bacteria documented to be present or suspected.
- Elevation and immobilization of involved area to decrease
- Cool, sterile saline dressings may decrease pain.
- Follow with moist heat to aid in localization of infection.
- Surgical incision and drainage rarely indicated in uncomplicated
- Administration of semisynthetic penicillin (nafcillin
or oxacillin) or first-generation cephalosporin (cefazolin) recommended
until definitive diagnosis, by skin or blood cultures, can be made
(Tables 1 and 2).
- Oral or parenteral clindamycin recommended for penicillin-allergic
- Usual duration of therapy: 5–10 days
caused by gram-negative bacilli or mixture of microorganisms, treat
for 10–14 days.
Table 1. Evidence-Based
Recommendations for Treatment of Skin and Soft-Tissue Infections