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Bouza E, Burillo A, Muñoz P. How to manage skin and soft-tissue infections in the emergency department. Curr Opin Infect Dis 2023; 36:81-88. [PMID: 36853739 DOI: 10.1097/qco.0000000000000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Our purpose is to review the state-of-the-art on the management of skin and soft tissue infections (SSTI) in emergency departments (ED).Although the information is scarce, SSTI may account for 3-30% of all cases presenting to an ED, of which 25-40% require hospital admission.SSTI include very different entities in aetiology, location, pathogenesis, extension, and severity. Therefore, no single management can be applied to them all. A simple approach is to classify them as non-purulent, purulent, and necrotising, to which a severity scale based on their systemic repercussions (mild, moderate, and severe) must be added.The initial approach to many SSTIs often requires no other means than anamnesis and physical examination, but imaging tests are an indispensable complement in many other circumstances (ultrasound, computerized tomography, magnetic resonance imaging…). In our opinion, an attempt at etiological filiation should be made in severe cases or where there is suspicion of a causality other than the usual one, with tests based not only on cultures of the local lesion but also molecular tests and blood cultures. RECENT FINDINGS Recent contributions of interest include the value of bedside ultrasound and the potential usefulness of biomarkers such as thrombomodulin to differentiate in early stages the presence of necrotising lesions not yet explicit.New antimicrobials will allow the treatment of many of these infections, including severe ones, with oral drugs with good bioavailability and for shorter periods. SUMMARY The ED has an essential role in managing SSTIs, in their classification, in decisions on when and where to administer antimicrobial treatment, and in the rapid convening of multidisciplinary teams that can deal with the most complex situations.
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Affiliation(s)
- Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute (IiSGM)
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
| | - Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute (IiSGM)
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute (IiSGM)
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
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Esposito S, Pagliano P, De Simone G, Pan A, Brambilla P, Gattuso G, Mastroianni C, Kertusha B, Contini C, Massoli L, Francisci D, Priante G, Libanore M, Bicocchi R, Borgia G, Maraolo AE, Brugnaro P, Panese S, Calabresi A, Amendola G, Savalli F, Geraci C, Tedesco A, Fossati S, Carretta A, Santantonio T, Cenderello G, Crisalli MP, Schiaroli E, Rovere P, Masini G, Ferretto R, Cascio A, Colomba C, Gioè C, Tumbarello M, Losito AR, Foti G, Prestileo T, Buscemi C, Iaria C, Iacobello C, Sonia S, Starnini G, Ialungo A, Sapienza M. Epidemiology, aetiology and treatment of skin and soft tissue infections: final report of a prospective multicentre national registry. J Chemother 2022; 34:524-533. [DOI: 10.1080/1120009x.2022.2075170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Silvano Esposito
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Pasquale Pagliano
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Giuseppe De Simone
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Angelo Pan
- Department of Infectious Diseases, Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Paola Brambilla
- Department of Infectious Diseases, Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Gianni Gattuso
- Department of Infectious Diseases, Carlo Poma Hospital, Mantova, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, Latina, Italy
| | - Blertha Kertusha
- Department of Public Health and Infectious Diseases, Sapienza University, Latina, Italy
| | - Carlo Contini
- Department of Medical Sciences, Section of Infectious Diseases and Dermatology, University of Ferrara, Ferrara, Italy
| | - Lorenzo Massoli
- Department of Medical Sciences, Section of Infectious Diseases and Dermatology, University of Ferrara, Ferrara, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, University Hospital “S. Maria”, University of Perugia, Perugia, Italy
| | - Giulia Priante
- Infectious Diseases Clinic, University Hospital “S. Maria”, University of Perugia, Perugia, Italy
| | - Marco Libanore
- Infectious Diseases Unit, Department of Infectious Diseases, S. Anna University Hospital, Ferrara, Italy
| | - Roberto Bicocchi
- Infectious Diseases Unit, Department of Infectious Diseases, S. Anna University Hospital, Ferrara, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Albert Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Pierluigi Brugnaro
- Infectious Diseases Department, Ospedale Civile “SS. Giovanni e Paolo”, Venice, Italy
| | - Sandro Panese
- Infectious Diseases Department, Ospedale Civile “SS. Giovanni e Paolo”, Venice, Italy
| | - Alessandra Calabresi
- Emergency Department, Hospital “Santi Antonio e Biagio e C. Arrigo”, Alessandria, Italy
| | - Giovanni Amendola
- Emergency Department, Hospital “Santi Antonio e Biagio e C. Arrigo”, Alessandria, Italy
| | | | - Consuelo Geraci
- Infectious Diseases Unit, Hospital of Trapani, Trapani, Italy
| | - Andrea Tedesco
- Infectious Diseases Unit, Hospital Fracastoro San Bonifacio, Verona, Italy
| | - Sara Fossati
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
| | - Anna Carretta
- Department of Infectious Diseases, University Hospital “Ospedali Riuniti” of Foggia, Foggia, Italy
| | - Teresa Santantonio
- Department of Infectious Diseases, University Hospital “Ospedali Riuniti” of Foggia, Foggia, Italy
| | | | | | - Elisabetta Schiaroli
- Department of Medicine, Section of Infectious Diseases, University of Perugia, Perugia, Italy
| | | | - Giulia Masini
- Infectious Diseases Unit, Legnago Hospital, Verona, Italy
| | - Roberto Ferretto
- Infectious Diseases Unit, “Alto Vicentino” Santorso Hospital, Vicenza, Italy
| | - Antonio Cascio
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Claudia Colomba
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Claudia Gioè
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Foundation Policlinico Universitario A. Gemelli IRCCS, Cattolica del Sacro Cuore University, Rome, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Foundation Policlinico Universitario A. Gemelli IRCCS, Cattolica del Sacro Cuore University, Rome, Italy
| | - Giuseppe Foti
- Infetious Diseases Unit, “Bianchi-Melacrino-Morelli” Hospital, Reggio Calabria, Italy
| | | | | | - Chiara Iaria
- Infectious Diseases Unit, Arnas Civico Hospital, Palermo, Italy
| | | | - Sofia Sonia
- Infectious Diseases Unit, Cannizzaro Hospital, Catania, Italy
| | | | - Anna Ialungo
- Infectious Diseases Unit, Belcolle Hospital, Viterbo, Italy
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Sjeklocha L, Tiffany L, Tran Q, Abdel-Wahab M, Widjaja A, Aligabi A, Albelo F, Asunción S, Gelmann D, Haase D, Henry S, Leibner E. Outcomes and factors associated with occult septic shock in emergency department patients with soft tissue Infection. J Emerg Trauma Shock 2022; 15:128-134. [PMID: 36353407 PMCID: PMC9639725 DOI: 10.4103/jets.jets_38_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/11/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Patients who develop occult septic shock (OSS) are associated with worse outcomes than those with early septic shock (ESS). Patients with skin and soft tissue infection (SSTI) may have underlying organ dysfunction due to OSS, yet the prevalence and the outcomes of patients with SSTI and early versus occult shock have not been described. This study compared the clinical characteristics of SSTI patients and the prevalence of having no septic shock (NSS), ESS, or OSS. Methods: We retrospectively analyzed charts of adult patients who were transferred from any emergency department to our academic center between January 1, 2014, and December 31, 2016. Outcomes of interest were the development of OSS and acute kidney injury (AKI). We performed logistic regressions to measure the association between clinical factors with the outcomes and created probability plots to show the relationship between key clinical variables and outcomes of OSS or AKI. Results: Among 269 patients, 218 (81%) patients had NSS, 16 (6%) patients had ESS, and 35 (13%) patients had OSS. Patients with OSS had higher mean serum lactate concentrations than patients with NSS (3.5 vs. 2.1 mmol/L, P < 0.01). Higher sequential organ failure assessment (SOFA) score was associated with higher likelihood of developing OSS (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.23–1.62, P < 0.001). NSS was associated with very low odds of developing AKI (OR 0.16, 95% CI 0.08–0.33, P < 0.001). Conclusions: 13% of the patients with SSTI developed OSS. Patients with OSS had elevated serum lactate concentration and higher SOFA score than those with NSS. Increased SOFA score is a predictor for the development of OSS.
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