Ropień skóry – Epidemiologia

Ropień skóry
Epidemiologia

Ropnie skóry stanowią jedne z najczęstszych infekcji skóry i tkanek miękkich (SSTI), charakteryzujące się lokalną kolekcją ropy w skórze właściwej lub przestrzeni podskórnej. Ich zapadalność wynosi około 24,6 przypadków na 1000 osób rocznie, a w warunkach szpitalnych chorobowość sięga 7-10%. Wzrost częstości występowania ropni wiąże się głównie z rozprzestrzenianiem się opornego na metycylinę gronkowca złocistego nabytego pozaszpitalnie (CA-MRSA), który odpowiada za 59% infekcji SSTI zgłaszanych na oddziałach ratunkowych. Czynniki ryzyka obejmują m.in. wiek 18-44 lata, płeć męską, przyjmowanie narkotyków dożylnie (z częstością ropni sięgającą 65%), cukrzycę, otyłość, immunosupresję oraz urazy skóry. Dominującym patogenem jest Staphylococcus aureus, z udziałem MRSA w około 22% przypadków ropni, szczególnie w infekcjach z rozległym rumieniem. Występują także zakażenia mieszane, co komplikuje empiryczną terapię antybiotykową.

Epidemiologia ropnia skóry

Ropnie skóry (skin abscess) należą do najczęstszych infekcji skóry i tkanek miękkich (SSTI – Skin and Soft Tissue Infections). Stanowią one lokalną kolekcję ropy w obrębie skóry właściwej lub przestrzeni podskórnej, powstającą w wyniku dezintegracji lub martwicy tkanki¹. Ze względu na częste występowanie i rosnącą oporność na antybiotyki ropnie skóry stanowią istotny problem epidemiologiczny w praktyce medycznej.

Częstotliwość występowania

Częstość występowania ropni skóry w ostatnich dekadach znacząco wzrosła, co częściowo przypisuje się pojawieniu się opornego na metycylinę gronkowca złocistego nabytego pozaszpitalnie (CA-MRSA) i jego predylekcji do wywoływania ropni skórnych¹². Szacunkowa zapadalność na ropnie skóry wynosi około 24,6 przypadków na 1000 osób rocznie¹². Współczynnik chorobowości w warunkach szpitalnych waha się od 7% do 10%¹.

W Stanach Zjednoczonych odnotowano dramatyczny wzrost liczby przypadków ropni i innych infekcji skóry w ostatnich dekadach. Według danych z 2005 roku, ropnie skóry doprowadziły do 3,4 miliona wizyt na oddziałach ratunkowych, co stanowiło 2,6% wszystkich wizyt w tych oddziałach, przy czym 13,9% wizyt skutkowało hospitalizacją¹². Ogólne wskaźniki wizyt związanych z infekcjami skóry i tkanek miękkich wzrosły z 32,1 do 48,1 wizyt na 1000 mieszkańców i osiągnęły 14,2 miliona do 2005 roku, przy czym wizyty związane z ropniami i zapaleniem tkanki łącznej wzrosły z 17,3 do 32,5 wizyt na 1000 mieszkańców i stanowiły ponad 95% tego wzrostu¹.

W Wielkiej Brytanii zaobserwowano również wzrost liczby hospitalizacji z powodu ropni i innych ciężkich infekcji skóry związanych ze stanami zapalnymi. Przyjęcia do szpitala z powodu ropni, czyraków, czyraczności i zapalenia tkanki łącznej niemal podwoiły się z 123 przyjęć na 100 000 w latach 1998/1999 do 236 przyjęć na 100 000 w latach 2010/2011¹.

Grupy ryzyka

Ropnie skóry mogą występować w każdej grupie wiekowej, ale częstość ich występowania różni się w zależności od wieku, płci i czynników ryzyka¹. Najczęściej obserwuje się je u osób w wieku 18-44 lat, mężczyzn i osób rasy czarnej¹. Szczególnie wysokie ryzyko rozwoju ropni skóry występuje u:

Osób przyjmujących narkotyki drogą dożylną (wskaźniki sięgające nawet 65% wśród użytkowników)¹²
Osób z obniżoną odpornością¹²
Pacjentów z cukrzycą¹²
Osób z otyłością¹²
Pacjentów z chorobami sercowo-płucnymi¹²
Osób z przewlekłą niewydolnością żylną¹
Pacjentów z obrzękiem limfatycznym¹
Osób po urazach, z ranami ciętymi, nacięciami chirurgicznymi¹
Personelu wojskowego podczas zagranicznych misji¹²
Sportowców uprawiających sporty kontaktowe¹
Osób przebywających w skupiskach ludzkich (więźniowie, bezdomni)¹²

Badania przeprowadzone wśród osób przyjmujących narkotyki drogą dożylną w Londynie wykazały wysoką częstość występowania infekcji skóry i tkanek miękkich w tej grupie, z 64% badanych zgłaszających wystąpienie ropnia i/lub zapalenia tkanki łącznej w ciągu życia, a ponad jedna trzecia (37%) zgłaszała ciężką infekcję¹².

Czynniki predysponujące

Do czynników zwiększających ryzyko powstania ropni skóry należą¹²:

Naruszenie ciągłości skóry (urazy, ukłucia, ugryzienia owadów, iniekcje)
Ciepłe, wilgotne środowisko
Nadmierna potliwość
Maceracja skóry
Tarcie
Wcześniejsze zapalenie skóry
Niedobory odporności, szczególnie neutrofili
Ciężkie niedożywienie
Palenie tytoniu

Patogeny wywołujące ropnie skóry

Staphylococcus aureus jest najczęstszym patogenem powodującym ropnie skóry¹²³. Jest on główną przyczyną infekcji skóry i tkanek miękkich, takich jak ropnie, czyraki i zapalenie tkanki łącznej¹.

Wzrost częstości występowania ropni skóry w ostatnich dekadach jest w dużej mierze przypisywany zwiększonej częstości zakażeń opornym na metycylinę gronkowcem złocistym (MRSA), szczególnie szczepami nabytymi pozaszpitalnie (CA-MRSA)¹². Według badań, CA-MRSA odpowiada za 59% infekcji skóry i tkanek miękkich zgłaszanych na oddziałach ratunkowych¹.

Częstość izolacji MRSA z ropni skóry wynosi około 22%, ale różni się znacząco w zależności od typu infekcji – MRSA izolowano z 36% ropni, 15% przypadków zapalenia tkanki łącznej i 14% innych infekcji skóry i tkanek miękkich¹. Odsetek MRSA jest najwyższy w ropniach z rozległym rumieniem¹.

Inne patogeny

Chociaż S. aureus jest dominującym patogenem, inne bakterie również mogą powodować ropnie skóry. Kolejność występowania to¹:

Staphylococcus aureus
Streptococcus spp. (głównie z grupy A)
Koagulazo-ujemne gronkowce
Bakterie Gram-ujemne
Bakterie beztlenowe

Częstość występowania zakażeń mieszanych, obejmujących zarówno bakterie Gram-dodatnie, jak i Gram-ujemne, waha się od 10% do 24%¹. Co istotne, badania wskazują, że te mieszane infekcje są związane ze zwiększonym ryzykiem niewłaściwej empirycznej terapii antybiotykowej¹.

Nadzór i obciążenie systemów opieki zdrowotnej

Ropnie skóry stanowią znaczące obciążenie dla systemów opieki zdrowotnej na całym świecie. Rzeczywisty zakres rozprzestrzeniania się infekcji ropni skóry jest nieznany, ponieważ łagodne przypadki często są samoograniczające się i pacjenci nie zawsze szukają pomocy medycznej¹.

Wpływ na system opieki zdrowotnej

Obciążenie i koszty związane z ostrymi infekcjami skóry w Stanach Zjednoczonych, w tym wizyty ambulatoryjne i hospitalizacje, są znaczne¹. W samym 2005 roku ropnie skóry były przyczyną 3,4 miliona wizyt na oddziałach ratunkowych w USA¹.

Niedawne badanie prospektywne wykazało, że jeden na pięciu pacjentów zgłaszających się do podstawowej opieki zdrowotnej z ropniem skóry spowodowanym przez MRSA wymaga dodatkowych interwencji, co kosztuje około 2000 dolarów na pacjenta¹.

W sektorze wojskowym infekcje skóry i tkanek miękkich również stanowią znaczne obciążenie operacyjne i zdrowotne. Badanie przeprowadzone wśród aktywnych członków sił zbrojnych USA w latach 2016-2020 wykazało, że 210 914 przypadków infekcji skóry i tkanek miękkich dotknęło 174 893 żołnierzy, skutkując 307 160 wizytami medycznymi i 14 819 dniami hospitalizacji¹².

Trendy czasowe

Częstość występowania ropni skóry znacząco wzrosła w ostatnich dekadach. W Anglii przyjęcia do szpitala z powodu ciężkich ropni gronkowcowych i czyraków potroiły się między 1989 a 2004 rokiem¹.

Badanie przeprowadzone w USA wykazało, że całkowita liczba przyjęć do szpitala z powodu infekcji skóry i tkanek miękkich wzrosła o 29% w latach 2000-2004, podczas gdy przyjęcia z powodu zapalenia płuc pozostały w dużej mierze niezmienione¹.

W Wielkiej Brytanii zapadalność na czyraki lub ropnie wynosiła 450 (95% CI 447-452) na 100 000 osobolat i nieznacznie wzrosła w okresie badania (współczynnik częstości występowania 1,005, 95% CI 1,004-1,007)¹. Rosnące wskaźniki hospitalizacji i nawrotów na tle stabilnej częstości występowania w społeczności sugerują zwiększoną ciężkość choroby¹.

W ostatnich latach, szczególnie od 2012 roku, dane wskazują na stabilizację lub nieznaczny spadek częstości występowania ropni w niektórych krajach, chociaż obciążenie chorobą pozostaje znaczące¹².

Różnice geograficzne i sezonowe

Zapalenie tkanki łącznej, które często współwystępuje z ropniami, wykazuje sezonową predylekcję do cieplejszych miesięcy w regionach nietropikalnych¹². Zjawisko to może również dotyczyć ropni skóry, szczególnie w kontekście czynników predysponujących jak ciepłe, wilgotne środowisko i nadmierna potliwość¹.

Występowanie CA-MRSA jako czynnika etiologicznego ropni różni się geograficznie. Szczep USA-300 jest dominującym klonem MRSA powodującym infekcje skóry i tkanek miękkich w Stanach Zjednoczonych¹. W Kanadzie dane z Canadian Paediatric Surveillance Program pokazują, że zakażenia CA-MRSA występują na terenie całego kraju¹.

Ropnie skóry w różnych populacjach

Ropnie u dzieci

Szacuje się, że około 4% dzieci doświadcza ropni skóry¹. Wzrost częstości występowania ropni skóry u dzieci w ostatnich dwóch dekadach przypisuje się pojawieniu się CA-MRSA i jego predylekcji do wywoływania ropni skórnych¹.

Czynniki ryzyka epidemiologicznego związane z rozprzestrzenianiem się CA-MRSA u dzieci lub w rodzinie obejmują bliski kontakt skóra-skóra, otwarcia w skórze, takie jak skaleczenia lub otarcia, zanieczyszczone przedmioty i powierzchnie, przeludnione warunki życiowe i słabą higienę¹.

Ropnie okołoodbytnicze są częstsze u chłopców niż u dziewcząt, a organizmy w tych ropniach to głównie mieszana flora beztlenowa i tlenowa jelita i skóry brzegu odbytu¹.

Ropnie u osób przyjmujących narkotyki drogą dożylną

Osoby przyjmujące narkotyki drogą dożylną (PWID) są szczególnie narażone na rozwój ropni skóry, z wskaźnikami sięgającymi 65% wśród użytkowników¹. Badanie przeprowadzone wśród PWID w Londynie wykazało wysoką częstość występowania infekcji skóry i tkanek miękkich w ciągu życia – 64% badanych zgłaszało wystąpienie ropnia i/lub zapalenia tkanki łącznej¹².

Ponad jedna trzecia (37%) osób przyjmujących narkotyki dożylnie zgłaszała ciężką infekcję, a 47% wymagało hospitalizacji¹. Infekcje te często wiążą się z innymi chorobami współistniejącymi, takimi jak posocznica, zapalenie wsierdzia, zakrzepica żył głębokich i choroby nerek¹².

Ropnie odbytnicze

Ropnie i przetoki okołoodbytnicze są powszechnymi łagodnymi chorobami odbytu i odbytnicy, znanymi od czasów starożytnego Egiptu¹. Niedawne badania lepiej określiły ich epidemiologię ze średnią częstością występowania 823 na 100 000 osób¹.

Dane potwierdzają, że 90% ropni okołoodbytniczych ma charakter kryptogenny (związany z infekcją gruczołów znajdujących się w kryptach odbytowych), ale zawsze należy brać pod uwagę zmiany związane z nieswoistymi zapaleniami jelit (IBD), ponieważ niedawno obliczono średnią częstość występowania na poziomie 4 na 100 000 osób¹.

Średni wiek pierwszej prezentacji ropni okołoodbytniczych wynosi 40 lat u obu płci, ale mężczyźni są dwukrotnie bardziej narażeni na rozwój ropnia okołoodbytniczego lub przetoki odbytu niż kobiety¹.

Powikłania i rokowanie

Większość ropni skóry reaguje dobrze na leczenie, ale nieleczone ropnie mogą prowadzić do poważnych powikłań. Jeśli ropień skóry pozostaje nieleczony, może samoistnie się opróżnić, jednak w ciężkich przypadkach może dojść do rozprzestrzenienia się ogólnoustrojowego i sepsy¹.

Powikłania

W przebiegu ropnia skóry możliwy jest szeroki zakres powikłań, w tym¹²:

Bakteriemia
Zapalenie wsierdzia
Zapalenie kości i szpiku
Infekcja przerzutowa
Sepsa
Zespół wstrząsu toksycznego

Infekcje skóry, które pozostają nieleczone, mogą przekształcić się w bardziej poważne infekcje zagrażające życiu, takie jak infekcje kości lub krwi¹.

Nawroty

Nawroty mogą wystąpić u około 20% pacjentów z ropniami skóry¹. Nawroty są szczególnie częste u pacjentów z ropniem skóry, zwłaszcza jeśli występuje kolonizacja MRSA i S. aureus wytwarzającym toksynę PVL¹.

Dokumentacja wcześniejszych zakażeń MRSA w dokumentacji medycznej może alertować klinicystów o wysokim prawdopodobieństwie MRSA w kolejnych infekcjach skóry i tkanek miękkich nadających się do hodowli¹.

Rokowanie

W zależności od zaawansowania choroby rokowanie może być różne. Generalnie jednak rokowanie w przypadku ropni skóry jest dobre¹. Większość infekcji skóry ustępuje bez leczenia, jednak niektóre infekcje wymagają nacięcia i drenażu lub leczenia antybiotykami w celu wyleczenia infekcji¹.

Strategie nadzoru i kontroli

Ze względu na rosnącą częstość występowania ropni skóry i związane z nimi obciążenie systemów opieki zdrowotnej, opracowano różne strategie nadzoru i kontroli.

Wytyczne diagnostyczne i lecznicze

Infectious Diseases Society of America (IDSA) i Centers for Disease Control and Prevention (CDC) opracowały wytyczne kliniczne dotyczące diagnostyki i leczenia ropni skóry¹. Wytyczne te podkreślają potrzebę:

Rozważenia MRSA w diagnostyce różnicowej wszystkich ropni skóry
Wykonania nacięcia i drenażu (I+D) ropni skóry
Wykorzystania wyników hodowli i wrażliwości na środki przeciwdrobnoustrojowe do kierowania leczeniem antybiotykami

IDSA zaleca leczenie antybiotykami tylko po nacięciu i drenażu ropnia, gdy występuje¹:

Ciężka lub rozległa choroba
Objawy choroby ogólnoustrojowej
Choroby współistniejące lub immunosupresja
Skrajny wiek
Ropień w obszarze trudnym do całkowitego drenażu (twarz, ręka, narządy płciowe)
Zapalenie żył septyczne
Brak odpowiedzi na samo nacięcie i drenaż

Badania przesiewowe i nadzór

Diagnostyka ropni skóry jest głównie kliniczna¹². U pacjentów z objawami ogólnoustrojowymi wskazane mogą być badania laboratoryjne, hodowle i obrazowanie w celu oceny ciężkości i dostosowania leczenia.

Badania krwi, poziom białka C-reaktywnego oraz testy funkcji wątroby i nerek powinny być zlecane u pacjentów z ciężkimi infekcjami oraz u osób z chorobami współistniejącymi powodującymi dysfunkcję narządów¹.

Posiewy krwi raczej nie zmienią postępowania w przypadku prostych, zlokalizowanych infekcji skóry i tkanek miękkich u zdrowych, immunokompetentnych pacjentów i zazwyczaj nie są konieczne. Jednak ze względu na potencjalne głębokie zajęcie tkanki, posiewy są przydatne u pacjentów z ciężkimi infekcjami lub objawami zaangażowania układowego, u osób starszych lub z obniżoną odpornością oraz u pacjentów wymagających operacji¹.

Ultrasonografia punktowa (POCUS) jest obiecującym narzędziem w diagnostyce ropni w przypadkach niepewności diagnostycznej, ze zgłaszaną czułością 95,5% (95% CI 88,9-98,3) i swoistością 80,3% (95% CI 56,4-92,7)¹.

Strategie zapobiegania

Strategie zapobiegania, wczesnej diagnostyki i definitywnego leczenia infekcji skóry i tkanek miękkich są uzasadnione, szczególnie w warunkach początkowego szkolenia wojskowego i operacyjnych związanych ze zwiększonym ryzykiem infekcji¹.

Wczesna diagnoza i leczenie ropni skóry, szczególnie w środowiskach wysokiego ryzyka, mają kluczowe znaczenie dla zmniejszenia znacznego obciążenia opieki zdrowotnej i kosztów, jakie te infekcje nakładają na systemy opieki zdrowotnej¹².

W przypadku pacjentów z nawracającymi ropniami należy podejrzewać niedobór odporności i rozważyć skierowanie do specjalisty¹.

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Materiały źródłowe

#1 A guide to abscesses in the skin
https://www.contemporarypediatrics.com/view/guide-abscesses-skin
Pediatricians can handle most cutaneous and subcutaneous abscesses. The site of the lesion, agent of infection, and age and immunologic status of the child are the keys to treatment strategies. […] Abscesses in the skin tend to look the same wherever they are on the body. The site of the abscess, along with the age and immunologic status of the patient, determines how the abscess is managed, however. […] The abscesses discussed here include furuncles and carbuncles, abscesses of the apocrine glands and the areas around the nail or rectum, and the breast and scalp abscesses found in the neonate. […] An abscess is a localized collection of pus in a cavity, formed when tissue disintegrates or necrotizes. […] Predisposing factors. Cutaneous and subcutaneous abscesses most often develop when a primary infection extends locally into the epidermis or dermis, for example when an abscess originates from a skin appendage, such as a furuncle, carbuncle, epidermal inclusion cyst, or, rarely, periporitis (a staphylococcal infection complicating miliaria).
#1 Skin and Soft-Tissue Infections | AMBOSS Rotation Prep
https://resident360.amboss.com/pediatrics/pediatric-infectious-diseases/skin-and-soft-tissue-infections/skin-and-soft-tissue-infections.html
Some data suggest that the incidence of SSTIs in children has increased during the past 2 decades due to the emergence of community-acquired MRSA and the organisms predilection to cause skin abscesses. The estimated incidence of SSTIs in children (age 17 years) is 43 per 1000 person-years (based on International Classification of Diseases, 9th edition [ICD-9] billing codes). Most culture-positive cases are caused by S. aureus. […] The results of this study suggest that MRSA colonization of household members and contamination of environmental surfaces in the household may be associated with MRSA skin and soft-tissue infections in children. […] These authors used ambulatory and inpatient data from the United States to determine the rate of skin and soft-tissue infections.
#1 Bacterial Skin Abscess | IntechOpen
https://www.intechopen.com/chapters/71743
Because of changing the display skin abscess, it was difficult to assess the incidence and prevalence. The incidence of skin abscess is 24.6 per 1000 people per year. […] Among patients in hospitals, the rate of prevalence ranges from abscess skiing 710%. […] The real spread of abscess skin infection is unknown because the light is usually self-occurrence and patients seeking medical care. […] According to national statistics for 2011 regarding the cost of health care project and use, skin abscess rate led to 3.4 million visits to the emergency department, or 2.6% of the total emergency department visits, with 13.9% of visits have led to hospitalization. […] These figures are on the rise due to the prevalence of Staphylococcus aureus resistant to methicillin-associated Balmethycelin in the past decade. […] A recent prospective study showed that one out of every 5 patients provide primary care clinic for skin abscess caused by Staphylococcus aureus resistant to methicillin (MRSA) require additional interventions at a cost of approximately $ 2000 per patient.
#1 Cellulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/214222-overview
Overall rates of visits increased for SSTIs from 32.1 to 48.1 visits per 1000 population and reached 14.2 million by 2005, and visits for abscess and cellulitis increased from 17.3 to 32.5 visits per 1000 population and accounted for more than 95% of the increase, according to the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The study provided data regarding visits by patients with SSTIs to physician offices, hospital outpatient departments, and emergency departments in the United States. […] Cellulitis was found to account for approximately 3% of emergency medical consultations at one United Kingdom district general hospital.
#1 Evidence for increasing severity of community-onset boils and abscesses in UK General Practice | Epidemiology & Infection | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/evidence-for-increasing-severity-of-communityonset-boils-and-abscesses-in-uk-general-practice/37260850FC4B372E83DC3D6EF1265D6D
In England, hospital admissions for severe staphylococcal boils and abscesses trebled between 1989 and 2004. […] The incidence of boil or abscess was 450 [95% confidence interval (CI) 447452] per 100 000 person-years and increased slightly over the study period (incidence rate ratio 1005, 95% CI 10041007). […] Hospital admissions for abscesses, carbuncles, furuncles and cellulitis almost doubled, from 123 admissions per 100 000 in 1998/1999 to 236 admissions per 100 000 in 2010/2011. […] Rising hospitalization and recurrence rates set against a background of stable community incidence suggests increased disease severity. […] Our study suggests increasing hospitalizations cannot be explained by more cases in primary care. Instead staphylococcal strains may have become more severe or more difficult to treat, causing recurrent infection. […] Our findings suggest the number of patients experiencing severe and recurrent staphylococcal skin disease in the community has increased, with a rise in the rate of repeat consultations in primary care and increased hospital admissions.
#1 Skin and Soft Tissue Infections | AAFP
https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html
Skin and soft tissue infections (SSTIs) account for more than 14 million physician office visits each year in the United States, as well as emergency department visits and hospitalizations. The greatest incidence is among persons 18 to 44 years of age, men, and blacks. Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) accounts for 59% of SSTIs presenting to the emergency department. […] Older age, cardiopulmonary or hepatorenal disease, diabetes mellitus, debility, immunosenescence or immunocompromise, obesity, peripheral arteriovenous or lymphatic insufficiency, and trauma are among the risk factors for SSTIs. Outbreaks are more common among military personnel during overseas deployment and athletes participating in close-contact sports. Community-acquired MRSA causes infection in a wide variety of hosts, from healthy children and young adults to persons with comorbidities, health care professionals, and persons living in close quarters.
#1 Abscess – Wikipedia
https://en.wikipedia.org/wiki/Abscess
Skin abscesses are common and have become more common in recent years. […] Risk factors include intravenous drug use, with rates reported as high as 65% among users. […] In 2005, in the United States 3.2 million people went to the emergency department for an abscess. […] In Australia around 13,000 people were hospitalized in 2008 for the disease.
#1 Soft tissue abscess | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/soft-tissue-abscess?lang=us
Soft tissue abscesses are common and can occur in all age groups 2. […] Factors that increase the likelihood of developing a soft tissue abscess include the following 1-3: immunosuppression, diabetes mellitus, obesity, cardiopulmonary disease, intravenous drug use, alcohol excess, chronic venous insufficiency, lymphedema, trauma, lacerations, surgical incisions, skin breach, infections elsewhere in the body. […] Soft tissue abscesses have been associated with the following conditions 1-3: ulcer (soft tissue), osteomyelitis, cellulitis, pyomyositis, infective endocarditis.
#1 Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK
https://pmc.ncbi.nlm.nih.gov/articles/PMC7360031/
Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. […] SSTI lifetime prevalence was high: 64% reported an abscess and/or cellulitis. Over one-third (37%) reported a severe infection, 137 (47%) reported hospitalisation. […] Abscess and cellulitis are very common among PWID in London. We corroborate findings indicating SSTIs are associated with risks, e.g. venous access problems, as well as other co-morbid conditions: septicaemia, endocarditis, DVT, and kidney disease. […] In the United Kingdom, SSTI prevalence is rising, with hospitalisations for severe injecting-related infections increasing annually from 2012.
#1 A guide to abscesses in the skin
https://www.contemporarypediatrics.com/view/guide-abscesses-skin
Processes that disrupt the integrity of the skin, such as severe malnutrition, may pave the way for abscesses. […] A deficiency in local or systemic immunologic defense, particularly of neutrophils, also can lead to abscesses. […] Pediatricians should suspect immunodeficiency, and consider a referral, when a child has recurrent abscesses. […] Causative organisms. S aureus is the most common pathogen in cutaneous and subcutaneous abscesses. […] The principal pathogens of abscesses vary with the location of the lesion, however. […] In general, the causative organism(s) should be identified whenever a neonate or an immunocompromised individual has an abscess. […] Epidemiology and etiology. These abscesses may or may not be preceded by folliculitis. […] Predisposing conditions include a warm, humid environment, obesity, excessive sweating, maceration, friction, and preexisting dermatitis.
#1 About Staphylococcus aureus – MN Dept. of Health
https://www.health.state.mn.us/diseases/staph/basics.html
S. aureus has long been recognized as one of the most important bacteria that cause disease in humans. It is the leading cause of skin and soft tissue infections such as abscesses (boils), furuncles, and cellulitis. […] Most infections caused by S. aureus are skin and soft tissue infections such as abscesses or cellulitis. […] Some serious S. aureus infections (such as pneumonia or bloodstream infections) typically require hospitalization and treatment with intravenous antibiotics. […] Most skin infections resolve without treatment, however, some infections require incision and drainage or antibiotic treatment to cure the infection. […] Skin infections that are left untreated can develop into more serious life-threatening infections such as infections of the bone or blood.
#1 Current Epidemiology, Etiology, and Burden of Acute Skin Infections in the United States
https://pmc.ncbi.nlm.nih.gov/articles/PMC6452002/
The US burden of acute skin infections is substantial. […] SSTIs in the United States have increased dramatically in incidence in recent decades. […] The burden of SSTIs and their complications are considerable, resulting in hospitalization, surgery, bacteremia, and, on occasion, death. […] An increase in S. aureus-associated SSTIs has been a major contributor to the US burden of skin infections. […] A concurrent rise in SSTIs due to methicillin-resistant S. aureus (MRSA) has also been observed in some studies. […] The prevalence of mixed Gram-positive and Gram-negative infections ranges from 10% to 24%. […] Importantly, several studies indicate that these mixed infections are associated with increased risk of inappropriate empiric antibiotic therapy. […] The burden and cost of acute skin infections in the United States, including ambulatory visits and hospitalizations, are substantial.
#1 Skin and soft-tissue infections in suburban primary care: epidemiology of methicillin-resistant Staphylococcus aureus and observations on abscess management | BMC Research Notes | Full Text
https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-4-33
Reports from urban medical centers suggest that methicillin-resistant Staphylococcus aureus (MRSA) has become the most common cause of skin and soft-tissue infections (SSTIs). […] The prevalence of MRSA was 22% and did not rise during the study. MRSA was isolated from 36% of abscesses, 15% of cellulitis, and 14% of other SSTIs. […] The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in skin and soft-tissue infections (SSTIs) has reached epidemic proportions in the United States (US) according to studies published since 2004. […] Most MRSA isolates from SSTIs in the United States are descended from a clone of MRSA known as USA-300. […] The proportion of MRSA was highest in abscesses and lower in cellulitis and other SSTIs. […] The prevalence of MRSA is relatively low among SSTIs in suburban primary care. However, MRSA is common in the subgroup of abscesses with large erythema. […] Documentation of prior MRSA in health records may alert clinicians to the high probability of MRSA in subsequent culturable SSTIs.
#1 Bacterial Skin and Soft Tissue Infections in Children
https://www.pidjournal.com/abstractArticleContentBrowse/PID/26120/JPJ/fullText
The most common causative organism is S. aureus followed by Streptococcus, coagulase-negative Staphylococcus, gram-negative organisms, and anaerobes in that order. […] Recurrences are common in patients with a skin abscess, especially if there is colonization with methicillin-resistant Staphylococcus aureus (MRSA) and S. aureus producing PVL toxin. […] Vancomycin is the antibiotic of choice for complicated abscesses. […] Methicillin-resistant Staphylococcus aureus, both community and hospital-acquired, is increasingly becoming a common isolate from various SSTIs, thus posing a serious worldwide health concern. […] Studies across the country have shown varying results regarding MRSA prevalence. […] It is important to know MRSA prevalence in ones hospital or local community for an effective antibiotic prescription. […] The following recommendations (2016) from National Centre for Disease Control, India must be kept in mind while treating MRSA infections:
#1 Skin and Soft Tissue Infections, Active Component, U.S. Armed Forces, January 2016âSeptember 2020 | Health.mil
https://health.mil/News/Articles/2021/04/01/Skin-Soft-Tissue-MSMR-2021
During the surveillance period, 210,914 incident cases of SSTIs affected 174,893 service members, resulting in 307,160 health care encounters and 14,819 hospital bed days. […] The annual incidence rates have fallen in recent years, but the burden of disease is still significant. […] SSTIs in the military are associated with significant operational and health care burden. […] Strategies for the prevention, early diagnosis, and definitive treatment of SSTIs are warranted, particularly in initial military training and operational settings associated with increased risk of infection. […] This report summarizes the frequencies, rates, and trends of incident diagnoses of SSTIs, overall and by type, among members of the active component of the U.S. Armed Forces from 1 Jan. 2016 through 30 Sept. 2020.
#1 Trends in US Hospital Admissions for Skin and Soft Tissue Infections – Volume 15, Number 9âSeptember 2009 – Emerging Infectious Diseases journal – CDC
https://wwwnc.cdc.gov/eid/article/15/9/08-1228_article
Using data from the 2000-2004 US Healthcare Cost and Utilization Project National Inpatient Sample, we found that total hospital admissions for skin and soft tissue infections increased by 29% during 2000-2004; admissions for pneumonia were largely unchanged. […] During 1998-2004, Staphylococcus aureus was the most common cause of skin and soft tissue infections (SSTIs) in North America; frequency of these infections was 44.6%, and the rate of methicillin resistance among the isolates was 35.9%. […] The increase in SSTI admissions was greatest among younger (age 65 years) rather than older patients (age 65-100 years) (37% vs. 14%, respectively) and for urban rather than rural hospitals (32% vs. 11%). […] While the estimated total number of SSTI admissions to US acute-care hospitals increased by 29% during 2000-2004, admissions for infectious pneumonia were largely unchanged. […] We therefore believe that the clinical and economic effects of CA-MRSA SSTIs are substantial and growing, and that this increase should be a focus of additional research.
#1 Soft Tissue Abscess | Concise Medical Knowledge
https://www.lecturio.com/concepts/soft-tissue-abscess/
Soft tissue abscesses are one of the commonly encountered skin and soft tissue infections. […] Incidence of abscesses rose throughout the 1990s; associated with an increase in methicillin-resistant Staphylococcus aureus (MRSA). […] Since the 2000s, the incidence of abscesses has plateaued. […] Abscesses can develop anywhere, but commonly are seen on the trunk, extremities, underarms, and buttocks.
#1 Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate
https://www.uptodate.com/contents/cellulitis-and-skin-abscess-epidemiology-microbiology-clinical-manifestations-and-diagnosis
Cellulitis and abscess are among the most common skin and soft tissue infections. Cellulitis (which includes erysipelas) manifests as an area of skin erythema, edema, and warmth; it develops as a result of bacterial entry via breaches in the skin barrier. A skin abscess is a collection of pus within the dermis or subcutaneous space. Misdiagnosis of these entities is common, and alternative diagnoses should be considered. […] The epidemiology, microbiology, clinical manifestations, and diagnosis of cellulitis and skin abscess are reviewed here. Specific epidemiologic factors (such as diabetes mellitus, animal bites, and water exposure) associated with skin and soft tissue infections are discussed separately. […] Cellulitis is observed most frequently among middle-aged and older adults. Erysipelas occurs in young children and older adults. The incidence of cellulitis is about 200 cases per 100,000 patient-years and, in nontropical regions, has a seasonal predilection for warmer months.
#1 Management of community-associated methicillin-resistant Staphylococcus aureus skin abscesses in chi | Canadian Paediatric Society
https://cps.ca/documents/position/methicillin-resistant-Staphylococcus-aureus-skin-abscesses
Uncomplicated skin abscesses in previously well children are typically managed with drainage alone. […] An increasing percentage of such abscesses are due to methicillin-resistant Staphylococcus aureus infections. […] Preliminary data from the Canadian Paediatric Surveillance Program show that CA-MRSA infections occur all across Canada. […] Epidemiological risk factors associated with the spread of CA-MRSA in the child or family include close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions and poor hygiene. […] Clusters or increased rates have been reported in Aboriginal populations, athletes, daycare attendees, military recruits, intravenous drug users, men who have sex with men, and prisoners, but many infected children have no risk factors.
#1 Cutaneous abscess – wikidoc
https://www.wikidoc.org/index.php/Cutaneous_abscess
It is estimated that 4% of children experience the cutaneous abscess. […] A national emergency department visit survey from 1996 to 2005 showed: Emergency department visits for abscesses more than doubled over the 10-year study period (1.2 million in 1996 to 3.28 million in 2005). […] Risk factors for developing cutaneous abscess include: Skin barrier disruption due to trauma (such as abrasion, penetrating wound, pressure ulcer, venous leg ulcer, insect bite, injection drug use). […] If cutaneous abscess left untreated it may drain spontaneously. However, in severe cases it may cause systemic spread and result in sepsis. […] Recurrence may occur in 20% of patients. […] A wide range of complications are possible in the course of skin abscess including: Bacteremia, endocarditis, osteomyelitis, metastatic infection, sepsis, and toxic shock syndrome. […] Depending on the extent of the disease, the prognosis may vary. However, the prognosis is generally regarded as good.
#1 A guide to abscesses in the skin
https://www.contemporarypediatrics.com/view/guide-abscesses-skin
Epidemiology and etiology. Hidradenitis suppurativa probably is initiated when the apocrine gland ducts become plugged with keratinous debris. […] Diagnosis. Early lesions are often mistaken for infected epidermal cysts, furuncles, scrofuloderma, actinomycosis, cat-scratch disease, granuloma inguinale, or lymphogranuloma venereum. […] Treatment. Patients should avoid tight-fitting clothes, which may exacerbate the condition. […] Epidemiology and etiology. Perirectal abscess is more common in boys than girls. […] The organisms in perirectal abscesses are predominantly mixed anaerobic and aerobic flora of the intestine and skin of the anal verge, including S aureus and S pyogenes as well as Bacteroides, Peptococcus, Peptostreptococcus, Porphyromonas, Fusobacterium, Clostridium, E coli, P aeruginosa, Klebsiella, Proteus, and enterococci.
#1 Epidemiology of Anal Fistula and Abscess | SpringerLink
https://link.springer.com/10.1007/978-3-030-76670-2_1
Perianal abscess and anal fistula are common anorectal benign diseases, known since ancient Egypt. […] Very recent studies have better defined their epidemiology with a mean prevalence of 823 per 100,000 people. […] Data confirm that 90% are cryptogenetic but IBD-associated lesions should always be considered because a mean prevalence of 4 per 100,000 people was recently calculated. […] The mean age of first presentation is reported to be 40 years in both sexes but men are twice as likely as women to develop perianal abscess or anal fistula. […] Smoking is still an important host risk factor. […] Research is moving into the comprehension of the complex interaction of host, local pro-inflammatory signals, and infections but data about microbiological factors in term of occurrence or recurrence are controversial.
#1 Management of Cutaneous Abscesses by Dermatologists – JDDonline – Journal of Drugs in Dermatology
https://jddonline.com/articles/management-of-cutaneous-abscesses-by-dermatologists-S1545961614P0119X/
IMPORTANCE: There is currently no data detailing the degree to which dermatologists follow CDC/Infectious Diseases Society of America (IDSA) guidelines in the treatment of abscesses, which recommend that incision and drainage (I+D) as primary therapy for skin and soft tissue infections (SSTI). […] The IDSA recommends cultures in all patients treated with antibiotic therapy, and does not recommend antibiotics for the treatment of simple abscess. […] The Centers for Disease Control and Prevention (CDC) have developed clinical care guidelines that emphasized the need to (a) consider MRSA in the differential diagnosis of all skin abscesses, (b) perform incision and drainage (I+D) of skin abscesses, and (c) to use culture results and antimicrobial sensitivity to guide antibiotic treatment. […] The Infectious Diseases Society of America recommends antibiotic treatment only after incision and drainage of an abscess when there is (a) severe of extensive disease, (b) signs and symptoms of systemic disease, (c) associated comorbidities of immunosuppression, (d) extremes in age, (e) abscess in an area difficult to drain completely (face, hand, genitalia), (f) associated septic phlebitis, (g) lack of response to incision and drainage alone. […] Identification of these practice gaps may impact physician practice and dermatology residency curricula, and may serve to improve abscess management and antibacterial stewardship in the outpatient setting.
#1 Skin and soft tissue infections – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/skin-and-soft-tissue-infections/
Skin abscess are primarily treated with incision and drainage while nonpurulent infections (e.g., erysipelas, cellulitis) require antibiotic therapy. […] S. aureus (often MRSA) is the most common pathogen for skin abscess. […] Diagnosis is usually clinical. In patients with systemic symptoms, laboratory studies, cultures, and imaging may be indicated to assess severity and tailor treatment. […] Incision and drainage are the mainstay of treatment for purulent SSTIs and are usually sufficient for mild infections. […] Patients with systemic signs of infections require empiric antibiotic therapy. […] The only way to definitively establish the causative pathogen is by obtaining a deep tissue culture (i.e., during surgical exploration). Clinical features alone are not reliable enough to distinguish between pathogens.
#1 Skin and Soft Tissue Infections | AAFP
https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html
The diagnosis of SSTIs is predominantly clinical. A complete blood count, C-reactive protein level, and liver and kidney function tests should be ordered for patients with severe infections, and for those with comorbidities causing organ dysfunction. Blood cultures are unlikely to change the management of simple localized SSTIs in otherwise healthy, immunocompetent patients, and are typically unnecessary. However, because of the potential for deep tissue involvement, cultures are useful in patients with severe infections or signs of systemic involvement, in older or immunocompromised patients, and in patients requiring surgery.
#1 Accuracy of Point-of-Care Ultrasound for Diagnosing Soft Tissue Abscess – TheNNT
https://thennt.com/lr/accuracy-point-care-ultrasound-diagnosing-soft-tissue-abscess/
Over 3 million cases of skin and soft tissue infections (SSTI) including cellulitis and abscesses are managed in U.S. emergency departments (EDs) each year. […] The systematic review summarized here included prospective cohort studies evaluating POCUS for diagnosis of abscess in ED patients. […] The primary outcome was diagnostic accuracy for abscess in the ED. […] The authors identified 8 relevant studies (n = 747 patients), with 3 conducted in adult ED and 5 in pediatric ED. […] Calculation of the point estimates for the diagnostic accuracy of POCUS found a sensitivity of 95.5% (95% confidence interval [CI] 88.9-98.3) and specificity of 80.3% (95% CI 56.4-92.7). […] Based on this evidence, the accuracy numbers reported in the systematic review do not appear reliably valid for typical or common POCUS use in SSTI. […] We believe that the diagnostic accuracy of POCUS is dependent on the pre-test probability of abscess. […] POCUS does appear, however, to be potentially helpful in identifying abscess in ED patients in cases of diagnostic uncertainty.
#1 Skin and Soft Tissue Infections, Active Component, U.S. Armed Forces, January 2016âSeptember 2020 | Health.mil
https://health.mil/News/Articles/2021/04/01/Skin-Soft-Tissue-MSMR-2021
The current analysis demonstrates that SSTI rates in the military are highest among new recruits/trainees and among those in a deployed setting. […] Early diagnosis and treatment of SSTI particularly in high-risk settings such as initial military training and deployment settings is critical to decreasing the significant health care burden and cost that these infections impose on the MHS.
#2 Bacterial Skin Abscess | IntechOpen
https://www.intechopen.com/chapters/71743
Because of changing the display skin abscess, it was difficult to assess the incidence and prevalence. The incidence of skin abscess is 24.6 per 1000 people per year. […] Among patients in hospitals, the rate of prevalence ranges from abscess skiing 710%. […] The real spread of abscess skin infection is unknown because the light is usually self-occurrence and patients seeking medical care. […] According to national statistics for 2011 regarding the cost of health care project and use, skin abscess rate led to 3.4 million visits to the emergency department, or 2.6% of the total emergency department visits, with 13.9% of visits have led to hospitalization. […] These figures are on the rise due to the prevalence of Staphylococcus aureus resistant to methicillin-associated Balmethycelin in the past decade. […] A recent prospective study showed that one out of every 5 patients provide primary care clinic for skin abscess caused by Staphylococcus aureus resistant to methicillin (MRSA) require additional interventions at a cost of approximately $ 2000 per patient.
#2 Cellulitis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/214222-overview
Because cellulitis is not a reportable disease, the exact prevalence is uncertain; however, it is a relatively common infection, affecting all racial and ethnic groups. There is no statistically significant difference in the incidence of cellulitis in men and women, and usually no age predilection is described. Nonetheless, studies have found a higher incidence of cellulitis in individuals older than 45 years. Cellulitis was more common in geriatric patients in a retrospective study of international travelers by the GeoSentinel Surveillance Network. […] A study of an insurance database in Utah found an incidence rate of 24.6 cases per 1000 person-years. The incidence was higher in males and in those individuals aged 45-64 years. In a large epidemiologic hospital-based study on skin, soft tissue, bone, and joint infections, 37.3% patients were identified as having cellulitis.
#2 Abscess – Wikipedia
https://en.wikipedia.org/wiki/Abscess
Skin abscesses are common and have become more common in recent years. […] Risk factors include intravenous drug use, with rates reported as high as 65% among users. […] In 2005, in the United States 3.2 million people went to the emergency department for an abscess. […] In Australia around 13,000 people were hospitalized in 2008 for the disease.
#2 Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK
https://pmc.ncbi.nlm.nih.gov/articles/PMC7360031/
Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. […] SSTI lifetime prevalence was high: 64% reported an abscess and/or cellulitis. Over one-third (37%) reported a severe infection, 137 (47%) reported hospitalisation. […] Abscess and cellulitis are very common among PWID in London. We corroborate findings indicating SSTIs are associated with risks, e.g. venous access problems, as well as other co-morbid conditions: septicaemia, endocarditis, DVT, and kidney disease. […] In the United Kingdom, SSTI prevalence is rising, with hospitalisations for severe injecting-related infections increasing annually from 2012.
#2 A guide to abscesses in the skin
https://www.contemporarypediatrics.com/view/guide-abscesses-skin
Processes that disrupt the integrity of the skin, such as severe malnutrition, may pave the way for abscesses. […] A deficiency in local or systemic immunologic defense, particularly of neutrophils, also can lead to abscesses. […] Pediatricians should suspect immunodeficiency, and consider a referral, when a child has recurrent abscesses. […] Causative organisms. S aureus is the most common pathogen in cutaneous and subcutaneous abscesses. […] The principal pathogens of abscesses vary with the location of the lesion, however. […] In general, the causative organism(s) should be identified whenever a neonate or an immunocompromised individual has an abscess. […] Epidemiology and etiology. These abscesses may or may not be preceded by folliculitis. […] Predisposing conditions include a warm, humid environment, obesity, excessive sweating, maceration, friction, and preexisting dermatitis.
#2 Skin and Soft Tissue Infections | AAFP
https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html
Skin and soft tissue infections (SSTIs) account for more than 14 million physician office visits each year in the United States, as well as emergency department visits and hospitalizations. The greatest incidence is among persons 18 to 44 years of age, men, and blacks. Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) accounts for 59% of SSTIs presenting to the emergency department. […] Older age, cardiopulmonary or hepatorenal disease, diabetes mellitus, debility, immunosenescence or immunocompromise, obesity, peripheral arteriovenous or lymphatic insufficiency, and trauma are among the risk factors for SSTIs. Outbreaks are more common among military personnel during overseas deployment and athletes participating in close-contact sports. Community-acquired MRSA causes infection in a wide variety of hosts, from healthy children and young adults to persons with comorbidities, health care professionals, and persons living in close quarters.
#2 Skin and Soft Tissue Infections, Active Component, U.S. Armed Forces, January 2016âSeptember 2020 | Health.mil
https://health.mil/News/Articles/2021/04/01/Skin-Soft-Tissue-MSMR-2021
During the surveillance period, 210,914 incident cases of SSTIs affected 174,893 service members, resulting in 307,160 health care encounters and 14,819 hospital bed days. […] The annual incidence rates have fallen in recent years, but the burden of disease is still significant. […] SSTIs in the military are associated with significant operational and health care burden. […] Strategies for the prevention, early diagnosis, and definitive treatment of SSTIs are warranted, particularly in initial military training and operational settings associated with increased risk of infection. […] This report summarizes the frequencies, rates, and trends of incident diagnoses of SSTIs, overall and by type, among members of the active component of the U.S. Armed Forces from 1 Jan. 2016 through 30 Sept. 2020.
#2 Management of community-associated methicillin-resistant Staphylococcus aureus skin abscesses in chi | Canadian Paediatric Society
https://cps.ca/documents/position/methicillin-resistant-Staphylococcus-aureus-skin-abscesses
Uncomplicated skin abscesses in previously well children are typically managed with drainage alone. […] An increasing percentage of such abscesses are due to methicillin-resistant Staphylococcus aureus infections. […] Preliminary data from the Canadian Paediatric Surveillance Program show that CA-MRSA infections occur all across Canada. […] Epidemiological risk factors associated with the spread of CA-MRSA in the child or family include close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions and poor hygiene. […] Clusters or increased rates have been reported in Aboriginal populations, athletes, daycare attendees, military recruits, intravenous drug users, men who have sex with men, and prisoners, but many infected children have no risk factors.
#2 Prevalence and severity of abscesses and cellulitis, and their associations with other health outcomes, in a community-based study of people who inject drugs in London, UK | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235350
Skin and soft tissue infections (SSTI) are a common but preventable cause of morbidity and mortality among people who inject drugs (PWID). They can be severe, and hospitalisations of PWID with SSTI are rising. The most common SSTI presentations are abscesses and cellulitis. […] SSTI lifetime prevalence was high: 64% reported an abscess and/or cellulitis. Over one-third (37%) reported a severe infection, 137 (47%) reported hospitalisation. […] Abscess and cellulitis are very common among PWID in London. We corroborate findings indicating SSTIs are associated with risks, e.g. venous access problems, as well as other co-morbid conditions: septicaemia, endocarditis, DVT, and kidney disease. These co-morbidities may impact SSTIs severity and outcomes. Delayed healthcare seeking potentially exacerbates infection severity, which in turn increases poorer health outcomes and complications.
#2 Bacterial Skin and Soft Tissue Infections in Children
https://www.pidjournal.com/abstractArticleContentBrowse/PID/26120/JPJ/fullText
Skin and soft tissue infections (SSTIs) are common in the pediatric age-group in developing countries, where the risk factors are commonplace. […] Most of them are secondary to Staphylococcus aureus and group I beta-hemolytic Streptococci. […] However, methicillin-resistant Staphylococcus aureus (MRSA) is a serious concern in cases worldwide, including India. […] The Infectious Diseases Society of America (IDSA) has classified the bacterial SSTIs based on practical usefulness for the clinicians: (i) skin extension: uncomplicated infections (uSSTI) with superficial involvement (impetigo, ecthyma, erysipelas, folliculitis, furunculosis), and complicated infections (cSSTI) usually with deep involvement (abscesses, cellulitis, carbuncles); […] An acute bacterial skin and skin structure infection (ABSSSI) is defined by the U.S. Food and Drug Administration (USFDA) as a bacterial infection of the skin with an area of redness, edema, or induration measuring at least 75 cm2. Cellulitis/erysipelas, and major cutaneous abscesses come under this category.
#2 Skin and Soft Tissue Infections, Active Component, U.S. Armed Forces, January 2016âSeptember 2020 | Health.mil
https://health.mil/News/Articles/2021/04/01/Skin-Soft-Tissue-MSMR-2021?page=6
During the surveillance period, 210,914 incident cases of SSTIs affected 174,893 service members, resulting in 307,160 health care encounters and 14,819 hospital bed days. […] The annual incidence rates have fallen in recent years, but the burden of disease is still significant. […] SSTIs in the military are associated with significant operational and health care burden. […] Strategies for the prevention, early diagnosis, and definitive treatment of SSTIs are warranted, particularly in initial military training and operational settings associated with increased risk of infection. […] The epidemiology of SSTIs in the MHS has been described previously. […] This report summarizes the frequencies, rates, and trends of incident diagnoses of SSTIs, overall and by type, among members of the active component of the U.S. Armed Forces from 1 Jan. 2016 through 30 Sept. 2020.
#2 Cellulitis and skin abscess: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate
https://www.uptodate.com/contents/cellulitis-and-skin-abscess-epidemiology-microbiology-clinical-manifestations-and-diagnosis/print
Cellulitis and abscess are among the most common skin and soft tissue infections. The epidemiology, microbiology, clinical manifestations, and diagnosis of cellulitis and skin abscess are reviewed here. Cellulitis is observed most frequently among middle-aged and older adults. Erysipelas occurs in young children and older adults. The incidence of cellulitis is about 200 cases per 100,000 patient-years and, in nontropical regions, has a seasonal predilection for warmer months.
#2 About Staphylococcus aureus – MN Dept. of Health
https://www.health.state.mn.us/diseases/staph/basics.html
S. aureus has long been recognized as one of the most important bacteria that cause disease in humans. It is the leading cause of skin and soft tissue infections such as abscesses (boils), furuncles, and cellulitis. […] Most infections caused by S. aureus are skin and soft tissue infections such as abscesses or cellulitis. […] Some serious S. aureus infections (such as pneumonia or bloodstream infections) typically require hospitalization and treatment with intravenous antibiotics. […] Most skin infections resolve without treatment, however, some infections require incision and drainage or antibiotic treatment to cure the infection. […] Skin infections that are left untreated can develop into more serious life-threatening infections such as infections of the bone or blood.
#2 Skin and soft tissue infections – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/skin-and-soft-tissue-infections/
Diagnosis is usually clinical. In patients with systemic symptoms, laboratory studies, cultures, and imaging may be indicated to assess severity and tailor treatment. […] Incision and drainage are the mainstay of treatment for purulent SSTIs and are usually sufficient for mild infections. […] S. aureus is the most common pathogen for any form of purulent SSTI; MRSA is frequently identified.
#2 Skin and Soft Tissue Infections, Active Component, U.S. Armed Forces, January 2016âSeptember 2020 | Health.mil
https://health.mil/News/Articles/2021/04/01/Skin-Soft-Tissue-MSMR-2021?page=6
The burden of SSTIs including numbers of individuals affected, total numbers of medical encounters, and hospital bed days, was assessed by quantifying the number of inpatient or outpatient medical encounters between 2016 and 2019 with a diagnosis of SSTI in the primary diagnostic position. […] Early diagnosis and treatment of SSTI particularly in high-risk settings such as initial military training and deployment settings is critical to decreasing the significant health care burden and cost that these infections impose on the MHS.
#3 Skin and soft tissue infections – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/skin-and-soft-tissue-infections/
Diagnosis is usually clinical. In patients with systemic symptoms, laboratory studies, cultures, and imaging may be indicated to assess severity and tailor treatment. […] Incision and drainage are the mainstay of treatment for purulent SSTIs and are usually sufficient for mild infections. […] S. aureus is the most common pathogen for any form of purulent SSTI; MRSA is frequently identified.