Department of Surgery, University of California, Irvine.
Clin Infect Dis. 2015 Sep 15;61 Suppl 2:S69-78. doi: 10.1093/cid/civ528.
Skin and soft-tissue infections (SSTIs) are an important cause of morbidity and mortality among hospitalized patients and a major therapeutic challenge for clinicians. Although uncomplicated SSTIs are managed successfully on an outpatient basis, more serious infections extending to the subcutaneous tissue, fascia, or muscle require complex management. Early diagnosis, selection of appropriate antimicrobials, and timely surgical intervention are key to successful treatment. Surgical-site infections, an important category of SSTI, occur in approximately half a million patients in North America annually. SSTIs are also a potential source for life-threatening bacteremia and metastatic abscesses. Gram-positive organisms, such as Staphylococcus aureus and Streptococcus pyogenes, are the dominant organisms isolated early in the infectious process, whereas gram-negative organisms are found in chronic wounds. Methicillin-resistant S. aureus (MRSA) is a potential bloodstream invader that requires aggressive antimicrobial treatment and surgery. Recent concerns regarding vancomycin activity include heteroresistance in MRSA and increase in the minimum inhibitory concentrations (>1 or 2 µg/mL); however, alternative agents, such as telavancin, daptomycin, linezolid, ceftaroline, dalbavancin, oritavancin, and tedizolid, are now available for the treatment of severe MRSA infections. Here, we present a review of the epidemiology, etiology, and available treatment options for the management of SSTIs.
皮肤和软组织感染（SSTIs）是住院患者发病率和死亡率的重要原因，也是临床医生面临的主要治疗挑战。虽然简单的 SSTIs 可以在门诊成功治疗，但更严重的感染延伸到皮下组织、筋膜或肌肉时，则需要复杂的管理。早期诊断、选择适当的抗生素以及及时的手术干预是成功治疗的关键。手术部位感染是 SSTI 的一个重要类别，每年在北美约有 50 万患者发生此类感染。SSTIs 也是导致威胁生命的菌血症和转移性脓肿的潜在源头。在感染过程的早期，革兰氏阳性菌（如金黄色葡萄球菌和化脓性链球菌）是主要分离菌，而革兰氏阴性菌则存在于慢性伤口中。耐甲氧西林金黄色葡萄球菌（MRSA）是一种潜在的血流感染入侵菌，需要积极的抗菌治疗和手术。目前人们对万古霉素活性的关注包括 MRSA 的异质性耐药和最小抑菌浓度（MIC）升高（>1 或 2 µg/mL）；然而，替拉万星、达托霉素、利奈唑胺、头孢洛林、达巴万星、奥利万星和替唑努地等替代药物现已可用于治疗严重的 MRSA 感染。在此，我们对 SSTIs 的流行病学、病因学以及现有治疗选择进行了综述。
