This practice guideline provides recommendations for the diagnosis and management of skin and soft-tissue infections in both healthy and immunocompromised hosts. The guideline emphasizes the importance of clinical assessment, laboratory testing, and appropriate antimicrobial therapy. Key points include: 1. **Clinical Assessment**: The severity of infection is crucial, and several classification schemes and algorithms have been proposed. However, most assessments are based on retrospective studies or clinical experience, highlighting the need for prospective studies with defined severity measurements. 2. **Laboratory Testing**: For patients with signs of systemic toxicity, blood cultures, complete blood cell counts, and creatinine, bicarbonate, creatine phosphokinase, and C-reactive protein levels should be performed. Hospitalization may be necessary if hypotension or elevated creatinine levels are present. 3. **Antimicrobial Therapy**: - **Simple Infections**: Semi-synthetic penicillins, first-generation or second-generation cephalosporins, macrolides, or clindamycin are recommended. - **MRSA Infections**: Vancomycin, linezolid, or daptomycin are preferred, with tetracycline or trimethoprim-sulfamethoxazole as alternatives. - **Erythema and Cellulitis**: Penicillin or penicillinase-resistant penicillins are the first-line treatments. Macrolide resistance is increasing, so alternative agents may be needed. - **Necrotizing Infections**: Monomicrobial or polymicrobial infections require specific antimicrobial agents, with parenteral clindamycin and penicillin being the first choices. 4. **Special Considerations**: - **Immunocompromised Patients**: Broad-spectrum antibiotics are often necessary, including agents active against MRSA and gram-negative bacteria. - **Animal and Human Bites**: Specific antibiotics are recommended based on the depth and severity of the wound. - **Surgical Site Infections**: Early surgical intervention is crucial for deep infections. 5. **Diagnosis and Management**: - **Impetigo**: Topical mupirocin is effective, but oral antibiotics are needed for multiple lesions or when topical treatments fail. - **Abscesses, Cellulitis, and Erysipelas**: Incision and drainage are often necessary, and systemic antibiotics are used for severe cases. - **Necrotizing Infections**: Early surgical intervention is essential, and antimicrobial therapy is crucial. 6. **Emerging Resistance**: The guideline addresses the increasing resistance of Staphylococcus aureus and Streptococcus pyogenes, emphasizing the need for appropriate empirical treatment and susceptibility testing. The guideline aims to provide a comprehensive approach to the diagnosis and management of skin and soft-tissue infections, ensuring that clinicians have the necessary tools to effectively treat these conditions.This practice guideline provides recommendations for the diagnosis and management of skin and soft-tissue infections in both healthy and immunocompromised hosts. The guideline emphasizes the importance of clinical assessment, laboratory testing, and appropriate antimicrobial therapy. Key points include: 1. **Clinical Assessment**: The severity of infection is crucial, and several classification schemes and algorithms have been proposed. However, most assessments are based on retrospective studies or clinical experience, highlighting the need for prospective studies with defined severity measurements. 2. **Laboratory Testing**: For patients with signs of systemic toxicity, blood cultures, complete blood cell counts, and creatinine, bicarbonate, creatine phosphokinase, and C-reactive protein levels should be performed. Hospitalization may be necessary if hypotension or elevated creatinine levels are present. 3. **Antimicrobial Therapy**: - **Simple Infections**: Semi-synthetic penicillins, first-generation or second-generation cephalosporins, macrolides, or clindamycin are recommended. - **MRSA Infections**: Vancomycin, linezolid, or daptomycin are preferred, with tetracycline or trimethoprim-sulfamethoxazole as alternatives. - **Erythema and Cellulitis**: Penicillin or penicillinase-resistant penicillins are the first-line treatments. Macrolide resistance is increasing, so alternative agents may be needed. - **Necrotizing Infections**: Monomicrobial or polymicrobial infections require specific antimicrobial agents, with parenteral clindamycin and penicillin being the first choices. 4. **Special Considerations**: - **Immunocompromised Patients**: Broad-spectrum antibiotics are often necessary, including agents active against MRSA and gram-negative bacteria. - **Animal and Human Bites**: Specific antibiotics are recommended based on the depth and severity of the wound. - **Surgical Site Infections**: Early surgical intervention is crucial for deep infections. 5. **Diagnosis and Management**: - **Impetigo**: Topical mupirocin is effective, but oral antibiotics are needed for multiple lesions or when topical treatments fail. - **Abscesses, Cellulitis, and Erysipelas**: Incision and drainage are often necessary, and systemic antibiotics are used for severe cases. - **Necrotizing Infections**: Early surgical intervention is essential, and antimicrobial therapy is crucial. 6. **Emerging Resistance**: The guideline addresses the increasing resistance of Staphylococcus aureus and Streptococcus pyogenes, emphasizing the need for appropriate empirical treatment and susceptibility testing. The guideline aims to provide a comprehensive approach to the diagnosis and management of skin and soft-tissue infections, ensuring that clinicians have the necessary tools to effectively treat these conditions.