Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America

Stevens, Dennis L.; Bisno, Alan L.; Chambers, Henry F.; Dellinger, E. Patchen; Goldstein, Ellie J. C.; Gorbach, Sherwood L.; Hirschmann, Jan V.; Kaplan, Sheldon L.; Montoya, José G.; Wade, James C.

doi:10.1093/cid/ciu296

Cited by 1,997 publications

(1,767 citation statements)

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“…No RCT could be found that compared the usefulness of achieving early source control in sepsis caused by necrotizing soft tissue infection, although there exist guidelines57, 58 and a review59 on this subject. Although early diagnosis and administration of broad‐spectrum antimicrobials can be effective in improving the prognosis of patients with necrotizing soft tissue infection, when treating patients with organ dysfunction arising from necrotizing soft tissue infection, that is, patients with sepsis, surgical intervention including swift and aggressive drainage of infected lesions is recommended by two different guidelines 57, 58.…”

Section: Introductionmentioning

confidence: 99%

“…Although early diagnosis and administration of broad‐spectrum antimicrobials can be effective in improving the prognosis of patients with necrotizing soft tissue infection, when treating patients with organ dysfunction arising from necrotizing soft tissue infection, that is, patients with sepsis, surgical intervention including swift and aggressive drainage of infected lesions is recommended by two different guidelines 57, 58. A review study examining the timing of surgical procedures also suggests that initiating surgery within 24 h after diagnosis can improve the mortality rate by ~20% more than surgeries performed after this period 59.…”

Section: Introductionmentioning

confidence: 99%

“…A review study examining the timing of surgical procedures also suggests that initiating surgery within 24 h after diagnosis can improve the mortality rate by ~20% more than surgeries performed after this period 59. If clinical symptoms persist after surgery, practical guidelines57 recommend performing reoperation while continuing antimicrobial administration for an additional 24–36 h. Based on the above, it is believed that surgery should be initiated at the earliest opportunity in cases of sepsis arising from necrotizing soft tissue infection.…”

Section: Introductionmentioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…[10][11][12] Interestingly, a recent prospective cohort study found that 43% of patients were overtreated with parenteral therapy (according to the Clinical Resource Efficiency Support Team [CREST] guidelines), with the authors suggesting that many of these cases could have been managed as outpatients with oral antibiotic therapy. 13 Although studies have been conducted in an effort to identify predictors of admission or prolonged hospital stay, [14][15][16] published clinical trials aiming to predict failure with oral antibiotics for SSTIs are currently lacking.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department

Yadav

Gatien

Corrales–Medina

et al. 2016

CJEM

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Objectives: We surveyed Canadian emergency physicians to determine how skin and soft tissue infections (SSTIs) are managed and which risk factors were felt to be important in predicting failure with oral antibiotics. Methods: We performed an electronic survey of physician members of the Canadian Association of Emergency Physicians (CAEP) using the modified Dillman method. Results: The survey response rate was 36.9% (n = 391) amongst CAEP members. There was a lack of consensus regarding management of SSTIs. CAEP respondents identified 14 risk factors for predicting treatment failure with oral antibiotics, including hypotension, tachypnea, and patient reported severity of pain >8 of 10. Conclusions: The survey demonstrates significant variability regarding physician management of SSTIs, and we have identified several perceived risk factors for treatment failure with oral antibiotics that should be assessed in future studies.

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“…Necrotizing fasciitis is a grievous infection of the deeper skin, subcutaneous tissues and fascia [1,2]. It is characterized by extensive and rapidly spreading necrosis and gangrene of the subcutaneous fat and fascia.…”

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confidence: 99%

Clinical evolution, management, and resolution of type II necrotizing fasciitis

et al. 2014

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A 60-year-old woman with a history of pre-diabetes and hyperlipidemia, presented to a local hospital with severe left flank pain and skin discoloration on the same area for 2 days. She had been taking care of her grandson who was diagnosed with streptococcal sore throat. On examination, the patient was hypotensive and tachycardic. There was a large grayish blue area over the left flank, extending to the left lower back (Fig. 1a, b). This area was very tender to palpation. There were no bullae, crepitus, or external drainage. A CT scan of the abdomen revealed a diffuse inflammatory process within the skin and soft tissue without any gas in the adjacent area. A diagnosis of necrotizing fasciitis was pursued. Broad-spectrum intravenous antibiotics (vancomycin, piperacillin-tazobactam, and clindamycin), and vasopressors were initiated, and she was transferred to our institution for further management. Upon arrival, she was immediately taken to the operating room for surgery. The operative findings showed there were extensive soft tissue necrosis and edematous fascial layers. A full-thickness debridement of skin and subcutaneous tissue of the left flank (24 cm 9 21 cm 9 1.5 cm) was performed (Fig. 1c). The tissue culture was positive for group A b-hemolytic Streptococcus (Streptococcus pyogenes). The pathogen was sensitive to penicillin (minimal inhibitory concentration, MIC 0.032 mg/L), ceftriaxone (MIC 0.064 mg/L), vancomycin (MIC 1.0 mg/L), and clindamycin (MIC not reported). Blood cultures were negative throughout the admission. Antibiotics were tailored to intravenous penicillin and clindamycin.Despite appropriate antimicrobial therapy, on day 3 of hospitalization, there were new areas of purplish red discoloration changes noted around the edge of the wound (Fig. 1d). She underwent additional debridement of skin and subcutaneous tissues (Fig. 1e). A day later (day 4 of hospitalization), it was again noted that the infection was extending upward to the left axilla at which point further debridement was undertaken (Fig. 1f). On day 6 of admission, extension of bluish gray skin changes occurred medially towards the suprapubic region (Fig. 1g), requiring an additional large area (20 cm 9 11 cm 9 2 cm) of surgical debridement (Fig. 1h). The negative pressure wound therapy devices were applied to the wounds, and the wound dressings were regularly changed under anesthesia. Vasopressors were successfully weaned off, and she continued to improve. On day 20 of hospitalization, the patient was eventually discharged home with negative pressure wound therapy. Approximately 2 months after the initial hospitalization, the abdominal and axillary wounds were found to be sufficiently granulated (Fig. 1i). She underwent definitive wound closure with split-thickness skin grafts harvested from the left thigh. One month post-skin graft follow-up (day 84 from the first hospitalization), skin grafts were taken very well without further complications (Fig. 1j).J. Makadia and Z. Min equally contributed to this manuscript.

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Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America

Cited by 1,997 publications

References 222 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department

Clinical evolution, management, and resolution of type II necrotizing fasciitis

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