Department of Medicine, Division of Infectious Diseases.
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Curr Opin Infect Dis. 2018 Apr;31(2):113-119. doi: 10.1097/QCO.0000000000000431.
To review the salient features of the management of severe skin and soft tissue infections (SSTIs), including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis.
For severe SSTIs, intensive care, source control, and broad-spectrum antimicrobials are required for the initial phase of illness. There is an increasing focus on the utility of rapid diagnostic tests to help in selection and de-escalation of antimicrobials for SSTIs. In addition, clinical prediction scores have shown promise in helping predict patients who do not require antimicrobials directed against methicillin-resistant Staphylococcus aureus. Immune status has been shown to be important in clinical outcomes of some, but not all types of SSTIs. The debate for benefits of intravenous immunoglobulin continues to be waged in the recent literature.
Severe SSTIs are common and their management complex due to regional variation in predominant pathogens and antimicrobial resistance patterns, as well variations in host immune responses. Unique aspects of care for severe SSTIs are discussed including the role of surgical consultation and source control. The unique features of SSTIs in immunocompromised hosts are also described.
回顾严重皮肤和软组织感染（SSTIs），包括中毒性休克综合征、肌坏死/气性坏疽和坏死性筋膜炎的管理要点。
对于严重的 SSTIs，在疾病的初始阶段需要重症监护、源头控制和广谱抗生素。越来越关注快速诊断测试在帮助选择和减少 SSTIs 抗生素方面的效用。此外，临床预测评分在帮助预测不需要针对耐甲氧西林金黄色葡萄球菌的抗生素的患者方面显示出了前景。免疫状态已被证明对某些但不是所有类型的 SSTIs 的临床结果很重要。最近的文献中仍在争论静脉注射免疫球蛋白的益处。
严重的 SSTIs 很常见，由于主要病原体和抗生素耐药模式的区域差异，以及宿主免疫反应的变化，其管理非常复杂。本文讨论了严重 SSTIs 独特的护理方面，包括手术咨询和源头控制的作用。还描述了免疫功能低下宿主中 SSTIs 的独特特征。
