Critical success factors for the management of complicated skin infections
Abstract number: S158
To guide the development of agents to treat skin and skin structure infections (SSSIs), the FDA has created two categories: uncomplicated infections (eg, simple abscesses, impetiginous lesions, furuncles, cellulitis) and complicated infections (deeper tissue involvement, often requiring significant surgical intervention, eg, abscesses, extensive cellulitis, diabetic foot infections, and necrotising infection). The latter infections, often with associated underlying disease, carry an increased risk of Gram-positive and Gram-negative co-pathogens. These infections, occurring in hospitalised patients, are unlikely to rapidly resolve with surgical measures alone; assessment of severity may help determine when emergency surgery and antibiotics are required. Severity assessments for SSSIs include clinical signs of systemic inflammation and local findings, particularly the size of abscesses or cellulitis, or signs of necrotising infection, including bullae and subcutaneous haemorrhage.
In these more severe cSSSIs, empiric therapy effective against the organisms subsequently identified on culture is important in limiting the extent of tissue loss and more rapidly resolving the acute illness. In the US and some European areas, the frequency of MRSA associated with SSSIs has risen dramatically in the past 5 years, reaching up to 60%. Because of the high prevalence of resistant strains in the community (community-acquired MRSA), recommendations in the US are to treat Staphylococcus aureus infections with agents active against MRSA and to assess microbiologic sensitivities when available.
Vancomycin has been the standard parenteral treatment for MRSA, but concerns exist regarding toxicity and increasing hetero- and other forms of resistance. New cephalosporins with activity against MRSA may provide clinicians with useful options for the treatment of cSSSIs. Ceftobiprole, an investigational broad-spectrum anti-MRSA cephalosporin, has demonstrated efficacy in two multi-centre, double-blind, active controlled trials in various types and severity of skin and soft tissue infections, including diabetic foot infections.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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