Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, F2/218 CSC 600 Highland Avenue, Madison, WI, 53792-3280, USA,
Curr Infect Dis Rep. 2014 Sep;16(9):418. doi: 10.1007/s11908-014-0418-9.
Skin and soft tissue infections (SSTIs) are frequently treated in the emergency department (ED) setting. Recent studies provide critical new information that can guide new approaches to the diagnosis and treatment of SSTIs in the ED. Rapid polymerase chain reaction assays capable of detecting MRSA in approximately 1 h hold significant potential to improving antibiotic stewardship in SSTI care. Emergency ultrasound continues to demonstrate value in guiding appropriate management of SSTIs, including the early diagnosis of necrotizing infections. Since emerging in the 1990s, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) continues to increase in prevalence, and it represents a significant challenge to optimizing ED antibiotic use for SSTI management. Growing literature reinforces the current recommendation of incision and drainage without antibiotics for uncomplicated abscesses. Selecting antibiotics with CA-MRSA coverage is recommended when treating purulent SSTIs; however, it is generally not necessary in cases of nonpurulent cellulitis. Future advances in ED SSTI care may involve expansion of outpatient parenteral antimicrobial therapy protocols and the recent development of a novel, once weekly antibiotic with activity against MRSA.
皮肤和软组织感染（SSTIs）在急诊科（ED）经常治疗。最近的研究提供了重要的新信息，可以指导 ED 中 SSTIs 的诊断和治疗的新方法。能够在大约 1 小时内检测 MRSA 的快速聚合酶链反应检测具有显著改善 SSTI 护理中抗生素管理的潜力。急诊超声继续证明在指导 SSTIs 的适当管理方面具有价值，包括早期诊断坏死性感染。自 20 世纪 90 年代出现以来，社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）的患病率继续增加，这对优化 ED 抗生素使用以管理 SSTI 构成了重大挑战。不断增加的文献证实了目前建议对单纯脓肿进行切开引流而不使用抗生素。当治疗脓性 SSTIs 时，建议选择具有 CA-MRSA 覆盖范围的抗生素；然而，在非脓性蜂窝织炎的情况下，通常没有必要。ED SSTI 护理的未来进展可能涉及扩大门诊肠外抗菌治疗方案，以及最近开发的一种针对 MRSA 具有活性的新型每周一次的抗生素。
