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Bacterial Skin and Soft Tissue Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Clinical response should be evaluated 48–72 hours after initiation of therapy as it can take a few days for cellulitis/erysipelas to start responding to appropriate antibiotic therapy. Conversely, patients whose conditions deteriorate despite empiric antibiotic therapy should be treated more aggressively on the basis of Gram staining, culture and antibiotic susceptibility. Worsening of acute bacterial skin and skin structure infection (ABSSSI) may indicate the presence of MRSA or Gram-negative organisms.
Lefamulin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Lefamulin is predominately excreted in feces (Wicha et al., 2010b). After administration of carbon 14 (14C)–labeled lefamulin to rats, 80% was recovered from the feces. A further 13% appeared in the urine. The plasma half-life in patients with skin and skin structure infection was 11.0–13.2 l/h. Linear lefamulin clearance was demonstrated in a single dose-escalation study of lefamulin 25 mg to 400 mg clearance with clearance of 18–25 l/h.
Staphylococcus aureus: Resistance Update and Treatment Options
Published in Robert C. Owens, Lautenbach Ebbing, Antimicrobial Resistance, 2007
Pamela A. Moise, George Sakoulas
S. aureus represents a common etiologic agent of skin and skin structure infection (SSSI), ranging in severity from mild to life-threatening disease and in community as well as nosocomial settings. The first step in management is to strotify by the presence or absence of systemic toxicity (e.g., hemodynamic instability, tachycardia, fever, or hypothermia). Patients demonstrating systemic toxicity should be admitted to an intensive care setting and evaluated by blood culture, hematology, and chemistry labs including a creatinine phosphokinase (CPK) level, and radiographic imaging of the involved site where indicated. Note, however, that even in cases of toxic shock syndrome caused by S. aureus soft tissue infection, the yield from blood cultures is very low (< 1%).
Novel developments in the treatment of acute bacterial skin and skin structure infections
Published in Expert Opinion on Pharmacotherapy, 2019
Rupal K. Jaffa, Kelly E. Pillinger, Danya Roshdy, Jacqueline A. Isip, Timothy R. Pasquale
Acute bacterial skin and skin structure infection (ABSSSI) represents a major burden on the United States (US) healthcare system, causing 2% of all hospitalizations and 14.2 million ambulatory visits per year [1,2] . In the early 2000s, the rising incidence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections, especially in young adults, changed the epidemiology of ABSSSI [3]. Although recent data indicate that the increase in ABSSSI incidence has slowed, it remains a frequent cause of infection, with an incidence twice that of urinary tract infections (UTIs) and 10 times that of pneumonia [4]. Many comorbid conditions, such as obesity, lymphedema, venous insufficiency, and prior trauma to the area have been associated with an increased risk of developing ABSSSI, as have social factors including tobacco use, intravenous drug use (IDU), and homelessness [5,6]. Several of these, including obesity and IDU, overlap with risk factors predisposing patients to MRSA infection (Table 1) [5,7].
Current and future treatment options for community-associated MRSA infection
Published in Expert Opinion on Pharmacotherapy, 2018
A. Khan, B. Wilson, I. M. Gould
IDSA guidelines advise that outpatients who present with purulent SSTI (e.g. cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess) should receive an empirical antibiotic active against CA-MRSA while awaiting culture results [32]. In non-purulent SSTI (cellulitis with no purulent drainage or exudate and no associated abscess), an ultrasound should be considered to rule out occult abscess [32]. For patients who are or become systemically unwell with severe or progressive infection (perhaps in the context of oral antibiotic therapy), inpatient management with surgical involvement for possible intervention is recommended [32]. The term acute bacterial skin and skin structure infection (ABSSSI) has replaced complicated SSTI (cSSTI) to describe patients presenting with severe infections that generally require intravenous therapy [75]. In terms of antimicrobial therapy, IDSA guidelines advise empirical MRSA therapy until culture results become available [32]. Recommended antibiotics include IV vancomycin, 600 mg PO/IV linezolid twice daily, 4 mg/kg/dose IV daptomycin once daily, 10 mg/kg/dose IV telavancin once daily, and 600 mg PO/IV clindamycin three times a day [32]. Tigecycline was not included in their recommended list as at the time of publishing of their guidelines there was an FDA warning indicating increased risk in all-cause mortality versus comparator drugs [32]. Tigecycline should be reserved for situations where other treatment options fail [76]. Televancin should be used with caution in those with renal insufficiency in light of the recent black box warning in product literature due to increased mortality in this patient group.