Trelease-Bell Amy
Maine-Dartmouth Family Medicine Residency, 15 East Chestnut St, Augusta, ME 04330.
FP Essent. 2020 Feb;489:11-15.
Patients with bacterial skin and soft tissue infections (SSTIs) commonly present to family physicians. Common uncomplicated bacterial SSTIs include impetigo, ecthyma, cellulitis, erysipelas, abscesses, furuncles, and carbuncles. Risk factors for SSTIs include older age and chronic medical conditions, such as diabetes and cardiopulmonary or renal disease, and immunocompromise. Staphylococci and streptococci are the most common pathogens. Uncomplicated impetigo and ecthyma can be managed with topical antibiotics. Oral antibiotics should be prescribed for patients with complicated impetigo and ecthyma and for patients with cellulitis. For patients with cellulitis and systemic signs of infection, systemic antibiotics are indicated but hospitalization or intravenous administration may not be required. Erysipelas can be managed with oral or intravenous penicillin. Purulent SSTIs by definition involve collections of pus and include abscesses, furuncles, and carbuncles. Larger abscesses are appropriate for incision and drainage. Patients with uncomplicated carbuncles or abscesses may not require antibiotics afterward. However, antibiotics are recommended for patients with systemic inflammatory response syndrome (SIRS), patients with carbuncles or abscesses who have not improved with initial antibiotic therapy, patients with impaired host defenses, and patients with SIRS and hypotension.
患有细菌性皮肤和软组织感染（SSTIs）的患者通常会去看家庭医生。常见的非复杂性细菌性SSTIs包括脓疱病、深脓疱病、蜂窝织炎、丹毒、脓肿、疖和痈。SSTIs的危险因素包括年龄较大以及患有慢性疾病，如糖尿病、心肺疾病或肾脏疾病，还有免疫功能低下。葡萄球菌和链球菌是最常见的病原体。非复杂性脓疱病和深脓疱病可用外用抗生素治疗。对于患有复杂性脓疱病和深脓疱病的患者以及蜂窝织炎患者，应开具口服抗生素。对于患有蜂窝织炎且有全身感染体征的患者，需要使用全身抗生素，但可能不需要住院或静脉给药。丹毒可用口服或静脉注射青霉素治疗。脓性SSTIs根据定义涉及脓液聚集，包括脓肿、疖和痈。较大的脓肿适合切开引流。非复杂性痈或脓肿患者之后可能不需要使用抗生素。然而，对于患有全身炎症反应综合征（SIRS）的患者、最初抗生素治疗后痈或脓肿未改善的患者、宿主防御功能受损的患者以及患有SIRS和低血压的患者，建议使用抗生素。
