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IDSA publishes guidelines for diagnosis, treatment of SSTIs
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Most skin and soft tissue infections are minor and heal on their own or are easily treated without antibiotics, according to new practices guidelines published by the Infectious Diseases Society of America.
According to Dennis L. Stevens, MD, PhD, chief of the infectious disease section of the Veterans Affairs Medical Center in Boise, Idaho, and lead author of the guidelines, skin and soft tissue infections (SSTIs) account for more than 6 million doctor visits each year. Most pus-filled SSTIs clear without treatment or should only be treated with incision and draining alone.
“We’ve provided guidance to help physicians make the correct diagnosis, establish the source and cause and determine the severity of infection, which is crucial,” Stevens said in a press release. “Antibiotics are life-saving drugs for many SSTIs, but should only be given when needed, and these guidelines will help physicians know when they are and are not necessary.”
According to Stevens, purulent SSTIs are usually no larger than a few inches, have a focal point of infection and are filled with pus. For mild infections, incision and drainage is the sole recommended treatment. For those with moderate or severe infections, culture and sensitivity testing is recommended, with empiric treatment based on the presence of systemic inflammatory response syndrome. Treatment should be tailored for MRSA or MSSA when culture results are available.
Nonpurulent SSTIs do not have a focal point and continue to spread. For mild nonpurulent infections, oral antibiotics are recommended, and for moderate infections, IV antibiotics are recommended. Severe infections, such as necrotizing fasciitis or group A streptococcus gangrene, require surgical debridement, empiric antibiotic treatment, and culture and sensitivity testing, followed by defined antibiotic treatment for necrotizing infections.
“SSTI is a very broad category and its diagnosis and treatment can be extremely complicated, depending on many factors from the symptoms, to the patient’s health, to the type of bacteria causing it,” Stevens said.
The guidelines contain a chart to guide physicians in diagnosing and treating SSTIs based on whether they are purulent or nonpurulent and on whether the infection is mild, moderate or severe. The guidelines also offer advice on treating SSTIs in immunocompromised patients.
Disclosure: See the guidelines for a list of the authors’ financial disclosures.
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