Skin and skin structure infections (SSSIs), also referred to as skin and soft tissue infections (SSTIs), or acute bacterial skin and skin structure infections (ABSSSIs), are infections of skin and associated soft tissues (such as loose connective tissue and mucous membranes). 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.

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

abscess An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...

es, impetiginous lesions, furuncles, 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 " perficial infections or abscesses in an anatomical site, such as the rectal area, where the risk of anaerobic or Gram-negative pathogen involvement is higher, ere alsoconsidered complicated infections." The uncomplicated category (uSSSI) is most frequently caused by ''

Staphylococcus aureus ''Staphylococcus aureus'' is a Gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive ...

'' 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

empirical Empirical evidence for a proposition is evidence, i.e. what supports or counters this proposition, that is constituted by or accessible to sense experience or experimental procedure. Empirical evidence is of central importance to the sciences and ...

, 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 Antimicrobial resistance (AMR) occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. All classes of microbes can evolve resistance. Fungi evolve antifungal resistance. Viruses evolve antiviral 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.

Types

Diagnosis

Treatment

See also

References

Further reading