World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections

Abstract

Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.

Early clinical assessment of response to treatment of skin and soft-tissue infections: how can it help clinicians? Perspectives from Europe

“…In general, a combination of surgical debridement or drainage and antibiotic treatment is used to treat the infection [1], although incision and drainage, without the need for antibiotics, is usually sufficient for treating simple abscesses or boils [30]. Determining the level of disease severity is an important first step in the clinical management of SSTIs in order to determine the type of care and empirical therapy [31].…”

Current guidelines and recommendations for the management of skin and soft tissue infections

“…The Surgical Infection Society (SIS) guidelines indicate the need to prescribe 'high dose' of antibiotics, using several examples such as penicillin or clindamycin, but do not provide any detailed suggestions [3]. Several guidelines indicate dose recommendations corresponding to the usually prescribed dose without any discussion of monitoring or dose changes related to clinical conditions [4,5,6 && ]. The best guidelines for adult and paediatric dosages are the IDSA recommendations, but dose monitoring and adjustments related to clinical conditions are not clearly addressed [7 && ].…”

Current understanding in source control management in septic shock patients: a review

“…A deep incision up to the fascia should be performed and if NF is diagnosed, radical debridement should be implemented. Recent guidelines (12,13) on the management of soft tissue and skin infections make recommendations on prompt and extensive surgery, and a second debridement when necessary to discard ongoing local extension, among the use of broad spectrum antibiotics. Seems prudent that, whenever possible, source control should be attempted as soon as foci is detected.…”

“…Antibiotics should be given as any septic shock patient in the first 6 hours, and administration of clindamycin is highly recommended in order to inhibit exotoxin production of Gram-positive bacteria. Duration of antibiotic treatment can be between 7-14 days according to guidelines (12,13).…”