S2k guidelines for skin and soft tissue infections Excerpts from the S2k guidelines for “calculated initial parenteral treatment of bacterial infections in adults – update 2018“

Abstract

ZusammenfassungDiese erste deutschsprachige S2k-Leitlinie zu bakteriellen Haut-und Weichgewebeinfektionen ist im Rahmen der "Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen" unter Federführung der Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. entstanden und wird in wichtigen Auszügen hier wiedergegeben.Voraussetzung für gut kalkulierte Antibiotikatherapien ist eine genaue diagnostische Zuordnung. So wird das Erysipel definiert als nichteitrige Infektion als deren Erreger β -hämolysierende Streptokokken gelten, und das klinisch diagnostiziert wird

Recurrent mucocutaneous infections caused by PVL‐positive Staphylococcus aureus strains: a challenge in clinical practice

“…In general, localized SSTIs such as abscesses, furuncles and carbuncles are preferably treated surgically . If feasible, the entire lesion should be excised, because simple incision and drainage might be associated with an increased risk of recurrence.…”

“…There are only few studies and recommendations with respect to antimicrobial treatment for PVL‐positive S. aureus . Small localized lesions (abscesses, furuncles) require antibiotic treatment only in exceptional cases (relevant immunosuppression, small children, clinical deterioration, as well as involvement of the face, hands or anogenital region) . For moderate SSTIs and/or large abscesses (> 5 cm) without systemic signs of infection, oral antibiotic therapy may be recommended.…”

“…In general, parenteral antibiotic treatment is only recommended for severe infections with systemic signs of infection. However, even without such signs, parenteral antibiotics are indicated for severe infections in critical sites (see above) as well as in patients with relevant immunosuppression or significant comorbidities (e.g., circulatory disorders, impaired gastrointestinal absorption) .…”

“…Bacterial decolonization aims to prevent clinical recurrence and transmission of PVL‐positive organisms , , . To date, however, there is only limited data on the efficacy of eradicating PVL‐positive S. aureus for prevention of recurrrent infections.…”

“…To date, however, there is only limited data on the efficacy of eradicating PVL‐positive S. aureus for prevention of recurrrent infections. Neither is there any long‐term follow‐up data of patients after successful bacterial decolonization that would enable us to determine exact recurrence rates . In some cases, decolonization is achieved only temporarily, and re‐colonization can occur relatively quickly .…”