Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS).
Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
Curr Opin Infect Dis. 2018 Apr;31(2):104-112. doi: 10.1097/QCO.0000000000000433.
To summarize and classify the most recent and relevant microbiological studies for each type of skin and soft tissue infection (SSTI).
Following Infectious Diseases Society of America and Food and Drug Administration classifications of SSTIs, we differentiate between two large groups, the superficial or uncomplicated infections and the complicated infections with deep involvement. It is not usually necessary to obtain microbiological samples in uncomplicated infections, except in cases of recurrences or for epidemiological control purposes. In the case of complicated infections, the samples are of two different types: those obtained from the affected area (surgical samples, punctures of abscesses or swabs) and systemic samples (i.e. blood cultures). The clinical condition also determines the type of samples to be obtained. In cases of systemic involvement, blood cultures are mandatory. For immunocompromised patients, who may present atypical infections, detection of antigens, serologies or molecular biology techniques may be helpful. The rapid diagnosis is currently the goal to be pursued by implementing techniques such as matrix assisted laser desorption ionization-time of flight, commercial real-time PCR or the promising metagenomics.
Microbiological diagnosis is one of the cornerstones of the management of SSTIs. Prompt obtaining and processing of the necessary samples, depending on the clinical situation of the patient, is of relevance in the decision-making process. Rapid and fluid reporting of the results (identification, mechanisms of resistance and antibiogram) will improve the management of these patients.
总结和分类各类皮肤软组织感染（SSTI）最新且相关的微生物学研究。
根据美国传染病学会和食品药品监督管理局对 SSTI 的分类，我们将其分为两组，即浅表或非复杂性感染和深部受累的复杂性感染。在非复杂性感染中，通常无需获取微生物样本，除非是复发或出于流行病学控制目的。对于复杂性感染，样本有两种不同类型：来自受影响区域的样本（手术样本、脓肿穿刺或拭子）和全身样本（即血培养）。临床情况也决定了要获取的样本类型。在出现全身感染的情况下，血培养是强制性的。对于免疫功能低下的患者，可能会出现非典型感染，检测抗原、血清学或分子生物学技术可能会有所帮助。目前的目标是通过实施基质辅助激光解吸电离飞行时间、商业实时 PCR 或有前途的宏基因组学等技术来实现快速诊断。
微生物学诊断是 SSTI 治疗的基石之一。根据患者的临床情况及时获取和处理必要的样本对于决策过程至关重要。快速、流畅地报告结果（鉴定、耐药机制和药敏谱）将改善这些患者的管理。
