Napolitano Lena M
Division of Acute Care Surgery, (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan Health System, Room 1C340A-UH, 1500 E. Medical Center Drive, SPC 5033, Ann Arbor, MI 48109-5033, USA.
Infect Dis Clin North Am. 2009 Sep;23(3):571-91. doi: 10.1016/j.idc.2009.04.006.
Severe skin and soft tissue infections (SSTIs) frequently require management in the ICU, in part related to associated septic shock or toxic shock syndrome or associated organ failure. Four fundamental management principles are key to a successful outcome in caring for patients who have severe SSTIs, including (1) early diagnosis and differentiation of necrotizing versus nonnecrotizing SSTI, (2) early initiation of appropriate empiric broad-spectrum antimicrobial therapy with consideration of risk factors for specific pathogens and mandatory coverage for methicillin-resistant Staphylococcus aureus (MRSA), (3) source control (ie, early aggressive surgical intervention for drainage of abscesses and debridement of necrotizing soft tissue infections), and (4) pathogen identification and appropriate de-escalation of antimicrobial therapy. MRSA has emerged as the most common identifiable cause of severe SSTIs; therefore, initiation of empiric anti-MRSA antimicrobials is warranted in all cases of severe SSTIs. In addition, appropriate critical care management-including fluid resuscitation, organ support and nutritional support-is a necessary component in treating severe SSTIs.
严重皮肤和软组织感染（SSTIs）常常需要在重症监护病房（ICU）进行治疗，部分原因与相关的感染性休克、中毒性休克综合征或相关器官衰竭有关。对于患有严重SSTIs的患者，四项基本治疗原则是取得成功治疗结果的关键，包括：（1）早期诊断并区分坏死性与非坏死性SSTI；（2）早期开始适当的经验性广谱抗菌治疗，同时考虑特定病原体的危险因素并对耐甲氧西林金黄色葡萄球菌（MRSA）进行必要覆盖；（3）源头控制（即对脓肿引流和坏死性软组织感染进行早期积极的手术干预清创）；（4）病原体鉴定及抗菌治疗的适当降阶梯。MRSA已成为严重SSTIs最常见的可识别病因；因此，在所有严重SSTIs病例中均有必要开始经验性抗MRSA抗菌治疗。此外，适当的重症监护管理，包括液体复苏、器官支持和营养支持，是治疗严重SSTIs的必要组成部分。
