Guay David R P
College of Pharmacy, University of Minnesota, Weaver-Densford Hall 7-115C, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
Expert Opin Pharmacother. 2003 Aug;4(8):1259-75. doi: 10.1517/14656566.4.8.1259.
Bacterial skin and skin structure infections (SSSIs) are among the most frequently seen infectious entities in the community setting and occasionally in the institutional setting. A wide variety of SSSIs exist, with cellulitis, impetigo and folliculitis being the most common. Most SSSIs are caused by aerobic staphylococci and streptococci, with aerobic Gram-negative bacilli and anaerobes being involved in more complicated infections. Systemic therapy with a variety of beta-lactams, macrolides and lincosamides (clindamycin) have been the cornerstone of SSSI therapy for many years. With the exception of mupirocin, topical therapy occupies a small therapeutic niche. Despite the emergence of antimicrobial resistance among the pathogens most commonly associated with SSSIs (for example, Streptococcus pyogenes and macrolides; Staphylococcus aureus and methicillin, vancomycin, penicillin and mupirocin), few treatment failures have been reported. The newest antimicrobials reviewed herein (linezolid, quinupristin/dalfopristin, gatifloxacin, gemifloxacin and moxifloxacin) are not a significant improvement upon older agents in the treatment of SSSIs. Perhaps this assessment will change if the penetrance of the antimicrobial resistance patterns described above reach a critical threshold and clinical failures become more widespread.
细菌性皮肤及皮肤结构感染（SSSIs）是社区环境中最常见的感染性疾病之一，在机构环境中也偶尔可见。存在多种类型的SSSIs，其中蜂窝织炎、脓疱病和毛囊炎最为常见。大多数SSSIs由需氧葡萄球菌和链球菌引起，需氧革兰氏阴性杆菌和厌氧菌则参与更复杂的感染。多年来，使用多种β-内酰胺类、大环内酯类和林可酰胺类（克林霉素）进行全身治疗一直是SSSI治疗的基石。除莫匹罗星外，局部治疗的应用范围较小。尽管与SSSIs最常相关的病原体（如化脓性链球菌与大环内酯类；金黄色葡萄球菌与甲氧西林、万古霉素、青霉素和莫匹罗星）出现了抗菌药物耐药性，但报道的治疗失败案例较少。本文所综述的最新抗菌药物（利奈唑胺、奎奴普丁/达福普汀、加替沙星、吉米沙星和莫西沙星）在治疗SSSIs方面相比旧有药物并无显著改善。如果上述抗菌药物耐药模式的发生率达到临界阈值且临床治疗失败变得更为普遍，或许这一评估会有所改变。
