University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Am Fam Physician. 2010 Apr 1;81(7):893-9.
The increasing incidence of skin and soft tissue infections requires family physicians to be familiar with the management of these conditions. Evidence of systemic infection, such as fever, tachycardia, and hypotension, is an indication for inpatient management. Urgent surgical referral is imperative for those with life-threatening or rapidly advancing infections. In patients with uncomplicated abscesses measuring less than 5 cm in diameter, surgical drainage alone is the primary therapeutic intervention. Wound irrigation using tap water has similar outcomes as irrigation using sterile water. When antimicrobials are indicated, choice of agents depends on local resistance and susceptibility patterns. In settings where suspicion of methicillin-resistant Staphylococcus aureus (MRSA) is low, beta-lactam antibiotics are the first-line treatments for uncomplicated skin and soft tissue infections without focal coalescence or trauma. When empiric coverage for MRSA is indicated and the infection is uncomplicated, oral agents, such as tetracyclines, trimethoprim/sulfamethoxazole, and clindamycin, are preferred. Vancomycin is the first-line agent for MRSA in hospitalized patients, and newer agents, such as linezolid, daptomycin, and tigecycline, should be reserved for patients who do not respond to or cannot tolerate vancomycin therapy. There are insufficient data to support eradicating the carrier state in patients with MRSA or their contacts with nasal mupirocin or antibacterial body washes. Standard infection-control precautions, including proper and frequent handwashing, are a mainstay of MRSA prevention.
皮肤和软组织感染的发病率不断上升，要求家庭医生熟悉这些疾病的治疗方法。有全身感染的证据，如发热、心动过速和低血压，表明需要住院治疗。对于那些有生命威胁或迅速进展的感染的患者，紧急手术转诊是必要的。对于直径小于 5 厘米的单纯脓肿患者，单纯手术引流是主要的治疗干预措施。使用自来水冲洗伤口的效果与使用无菌水冲洗相同。如果需要使用抗生素，则药物的选择取决于当地的耐药性和药敏模式。在怀疑耐甲氧西林金黄色葡萄球菌（MRSA）的可能性较低的情况下，对于无局灶性融合或创伤的单纯皮肤和软组织感染，β-内酰胺类抗生素是一线治疗药物。如果需要经验性覆盖 MRSA 且感染不复杂，口服药物如四环素、复方磺胺甲噁唑和克林霉素是首选。万古霉素是住院患者治疗 MRSA 的一线药物，对于不能耐受或不能耐受万古霉素治疗的患者，新型药物如利奈唑胺、达托霉素和替加环素应保留使用。目前尚无足够的数据支持对 MRSA 患者或其接触者进行鼻腔莫匹罗星或抗菌沐浴液清除带菌状态。标准的感染控制预防措施，包括正确和频繁的洗手，是预防 MRSA 的主要措施。
