Sharma S, Verma K K
Department of Dermatology and Venereology, All India Institute ofMedical Sciences, New Delhi.
Indian J Pediatr. 2001 Jul;68 Suppl 3:S46-50.
Abstract. Normal skin is heavily colonized by bacterial flora. The most common are the various nonpathogenic gram-positive bacteria such as Staphylococcus epidermidis (coagulase-negative). Skin and soft tissue infections are usually caused by Staphylococcus aureus (S. aureus) and Streptococcus pyogenes. This article discusses common and some not so common bacterial skin infections, including impetigo, folliculitis, furncles and carbuncles, cellulitis and erysipelas, gangrenous cellulitis, staphylococcal scalded skin syndrome and scarlet fever. Impetigo and ecthyma are common bacterial infections of the skin commonly caused by S. aureus and / or Group A streptoccus. In mild and localized impetigo topical antibiotics whereas in widespread or severe one and in ecthyma systemic antibiotics like, cloxacillin, erythromycin, azithromycin or cephalexin should be used. Folliculitis, furunculosis and carbuncle are folliculocentric infections caused by S. aureus involving the variable depth and extent of the follicle(s) and surrounding tissue. These conditions can be treated with topical or systemic antibiotics like cloxacillin, cephalexin, erythromycin, amoxicillin/clavulanic acid or vancomycin. Staphylococcal scalded skin syndrome is a toxin mediated exfoliative dermatosis caused by S. aureus of phase group II. Intravenous penicillinase-resistant anti-staphylococcal antibiotics like methicillin, cloxacillin, cephalosporin or erythromycin are required. Erysipelas and cellulitis are acute infections of dermal and subcutaneous tissues caused most frequently by Group A beta-hemolytic streptococci (erysipelas) or S. aureus requiring systemic antibiotics like oral or intravenous penicillin, erythromycin, cephalexin, cloxacillin, vacomycin, minocycline or ciprofloxacin depending upon the severity, suspected causative organism and culture/sensitivity results. Gangrenous cellulitis is characterized by infection with necrosis of skin and underlying subcutaneous tissue due to various pathogens occurring at different site. Ampicillin, gentamicin, and either metronidazole or clindamycin intravenously in standard doses are recommended for the treatment.
摘要。正常皮肤被细菌菌群大量定植。最常见的是各种非致病性革兰氏阳性菌，如表皮葡萄球菌（凝固酶阴性）。皮肤和软组织感染通常由金黄色葡萄球菌和化脓性链球菌引起。本文讨论了常见的以及一些不太常见的细菌性皮肤感染，包括脓疱病、毛囊炎、疖和痈、蜂窝织炎和丹毒、坏疽性蜂窝织炎、葡萄球菌性烫伤样皮肤综合征和猩红热。脓疱病和深脓疱是常见的皮肤细菌感染，通常由金黄色葡萄球菌和/或A组链球菌引起。轻度局限性脓疱病使用外用抗生素，而广泛或严重的脓疱病以及深脓疱则应使用全身抗生素，如氯唑西林、红霉素、阿奇霉素或头孢氨苄。毛囊炎、疖病和痈是以毛囊为中心的感染，由金黄色葡萄球菌引起，累及毛囊及周围组织的不同深度和范围。这些病症可用外用或全身抗生素治疗，如氯唑西林、头孢氨苄、红霉素、阿莫西林/克拉维酸或万古霉素。葡萄球菌性烫伤样皮肤综合征是由II相组金黄色葡萄球菌引起的毒素介导的剥脱性皮炎。需要静脉注射耐青霉素酶的抗葡萄球菌抗生素，如甲氧西林、氯唑西林、头孢菌素或红霉素。丹毒和蜂窝织炎是真皮和皮下组织的急性感染，最常见的病因是A组β溶血性链球菌（丹毒）或金黄色葡萄球菌，根据严重程度、疑似病原体及培养/药敏结果，需要使用全身抗生素，如口服或静脉注射青霉素、红霉素、头孢氨苄、氯唑西林、万古霉素、米诺环素或环丙沙星。坏疽性蜂窝织炎的特征是不同部位因各种病原体感染导致皮肤和皮下组织坏死。建议静脉注射标准剂量的氨苄西林、庆大霉素以及甲硝唑或克林霉素进行治疗。
