Toschi Alice, Giannella Maddalena, Viale Pierluigi
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna.
Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Curr Opin Infect Dis. 2025 Apr 1;38(2):71-77. doi: 10.1097/QCO.0000000000001096. Epub 2025 Feb 19.
Recurrent skin and soft tissue infections (RSSTIs) are challenging for the clinicians due to morbidity and healthcare-related costs. Here, we review updates on risk factors and management.
RSSTIs rates range between 7 and 45%. Local and systemic conditions can favour RSSTIs, with comorbidities such as obesity, diabetes, cancer and immunosuppressive disease becoming increasingly relevant. Streptococcus spp . and Staphylococcus aures (including methicillin resistant, MRSA) are the leading causative pathogens of RSSTIs, but also Gram-negative bacteria and polymicrobial infection should be considered. To prevent recurrences, treatment of underlying predisposing factor, complete source control and appropriate antibiotic therapy are crucial. Antibiotic prophylaxis for recurrent erysipelas and decolonization for MRSA carriers demonstrated some advantages, but also long-term loss of efficacy and possible adverse effects. Clinical score and patients risk stratification could be useful tools to target prophylaxis and decolonization strategies. To reduce hospitalization rates and costs, outpatient oral and parenteral antibiotic therapy (OPAT) and long-acting antibiotics are being implemented.
Management of RSSTIs requires both preventive interventions on modifiable risk factors and pharmacological strategies, with a patient tailored approach.
复发性皮肤和软组织感染（RSSTIs）因发病率和医疗相关成本给临床医生带来挑战。在此，我们综述风险因素和管理方面的最新进展。
RSSTIs的发生率在7%至45%之间。局部和全身状况可促使RSSTIs发生，肥胖、糖尿病、癌症和免疫抑制性疾病等合并症的相关性日益增加。链球菌属和金黄色葡萄球菌（包括耐甲氧西林金黄色葡萄球菌，MRSA）是RSSTIs的主要致病病原体，但也应考虑革兰氏阴性菌和混合感染。为预防复发，治疗潜在的诱发因素、彻底的源头控制和适当的抗生素治疗至关重要。复发性丹毒的抗生素预防和MRSA携带者的去定植显示出一些优势，但也存在长期疗效丧失和可能的不良反应。临床评分和患者风险分层可能是针对预防和去定植策略的有用工具。为降低住院率和成本，正在实施门诊口服和胃肠外抗生素治疗（OPAT）以及长效抗生素。
RSSTIs的管理需要对可改变的风险因素进行预防性干预和采取药理学策略，并采用针对患者的方法。
