Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive
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Skin and soft tissue infections represent a heterogeneous group of clinical entities that require to be accurately identified for an appropriate and immediate management. Clinicians are challenged by the need to rapidly select those patients requiring hospitalization and medical therapy only and those to be immediately submitted to surgery. Erysipelas and several forms of cellulitis, involving the superficial structures of epidermis and dermis, are medical conditions; some cutaneous abscess may require surgical drainage, and all the necrotizing infections, involving the subcutaneous tissue (necrotizing fasciitis) or muscles (myonecrosis) are surgical conditions. Among the clinical clues useful for the diagnosis are the presence of severe pain disproportionate to the clinical evidence of the lesion (necrotizing fasciitis), the presence of crepitus (gas gangrene) and signs of systemic toxicity (high fever, hypotension, tachycardia, shock and multiple organ failure).
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Skin and soft tissue infections (SSTIs) are a set of commonly observed pathologies which can present different features in terms of site and localization, clinical features, and the aetiological agent; their severity is related to the depth of the affected sites. The aim of this review is to summarize the recommendations of current guidelines concerning the management of SSTIs.
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Therapeutic strategies in the management of skin and soft tissue infections should take account of different variables: epidemiological trends (community or hospital acquired infections), pathogen or pathogens involved, virulence, seriousness of pathology (possible co-morbidities, knowledge of local epidemiology and antimicrobial susceptibility patterns of community and hospital strains. Therapy often should be started promptly, and on an empiric base, once microbiological analysis have been performed, waiting for culture and antimicrobial susceptibility testing. Surgical incision and drainage represent essential therapeutic procedures in the treatment of many complicated skin and soft tissue infections such as abscesses and fasciitis. ⋯ In Italy, the multidisciplinary group of Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI) published guidelines for the treatment of skin and soft tissue infections in Internal Medicine wards in 2005. General approach and methodology in writing test were based on analysis of data from available scientific literature and comparing them with actual Italian epidemiological trends and drug prescribing policy. Considering these guidelines, we updated the newest antimicrobial drugs suggested for the treatment of skin and soft tissue infections, such as daptomycin and tigecycline.