Hanses Frank
Interdisziplinäre Notaufnahme und Stabsstelle Infektiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93043, Regensburg, Deutschland.
Z Rheumatol. 2017 Nov;76(9):745-751. doi: 10.1007/s00393-017-0378-1.
Bacterial skin and soft tissue infections are frequent and represent one of the most important differential diagnoses in patients presenting with reddened and swollen skin and soft tissue. Among these infections, cellulitis (phlegmon), erysipelas and abscesses are the most frequent. Whereas erysipelas is almost exclusively caused by streptococci and can be successfully treated with penicillin, an effective antibiotic therapy targeted at Staphylococcus aureus should be empirically considered for abscesses and phlegmon; other pathogens, such as gram negative and anaerobic bacteria can be found in patients with the corresponding underlying disease and certain risk factors. Severe necrotizing soft tissue infections are acutely life-threatening and require rapid and broad antibiotic therapy followed by immediate surgery. Depending on the medical history or exposure (including bite wounds), other pathogens may have to be considered in special situations including the increasing prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) outside hospitals.
细菌性皮肤和软组织感染很常见，是皮肤和软组织发红、肿胀患者最重要的鉴别诊断之一。在这些感染中，蜂窝织炎（脓性蜂窝织炎）、丹毒和脓肿最为常见。丹毒几乎完全由链球菌引起，可用青霉素成功治疗，对于脓肿和脓性蜂窝织炎，应根据经验考虑针对金黄色葡萄球菌的有效抗生素治疗；在患有相应基础疾病和某些危险因素的患者中可发现其他病原体，如革兰氏阴性菌和厌氧菌。严重的坏死性软组织感染会急性危及生命，需要迅速进行广泛的抗生素治疗，随后立即进行手术。根据病史或接触情况（包括咬伤），在特殊情况下可能需要考虑其他病原体，包括医院外社区获得性耐甲氧西林金黄色葡萄球菌（MRSA）的患病率不断上升。
