Related Articles

Antibiotics, skin and soft tissue infection and meticillin-resistant Staphylococcus aureus: cause and effect.

Int J Antimicrob Agents. 2009 Jul;34 Suppl 1:S8-11

Authors: Gould IM

Staphylococcus aureus is not a new cause of skin and soft tissue infection, but the significance of the Panton-Valentine leukocidin toxin and the spread of several clones carrying different staphylococcal cassette chromosome (SCC) mecA gene cassette types have given it a new lease of life. This is a clinical area with several epidemic strains causing major problems around the world, most notably in the USA. While most attention focuses on treatment, prevention should be the goal. Traditional infection control measures, such as good hand hygiene and barrier precautions, are usually emphasised. Most importantly, we should not forget the underlying cause of meticillin-resistant Staphylococcus aureus (MRSA), namely antibiotic use. In both community and hospital, exposure to beta-lactams, in particular cephalosporins, and also sometimes quinolones and macrolides, is likely to promote the transmission, colonisation and increased virulence of MRSA. Future antibiotic policies should consider this, particularly in an era of widespread MRSA screening.

PMID: 19560675 [PubMed - indexed for MEDLINE]

Related Articles

New antibiotics for the management of complicated skin and soft tissue infections: are they any better?

Int J Antimicrob Agents. 2009 Jul;34 Suppl 1:S24-9

Authors: Nathwani D

A large number of novel antibacterial agents have been or are being developed for the treatment of complicated skin and soft tissue infections (cSSTIs). Only linezolid, daptomycin and tigecycline are available for clinical use. The clinical decision-making process around antibiotic choice in the empirical setting or where cultures are available is dependent on a variety of factors. Important parameters that appear to determine the clinical effectiveness of an antibiotic for cSSTIs include the severity of the illness, patient co-morbidities, whether the patient receives appropriate antimicrobial therapy at the onset of illness and if this should be a combination or single-agent approach to cover a broad range of likely causative organisms. The importance of these is discussed and the effectiveness of the new agents against current standard-of-care comparators is measured using a number of outcomes. The data presented do not provide a clear and robust case for widespread empirical use of new agents, but suggest a more measured, patient-centred, risk-benefit approach to antibiotic choice.

PMID: 19560672 [PubMed - indexed for MEDLINE]

Related Articles

Skin and soft tissue infection: microbiology and epidemiology.

Int J Antimicrob Agents. 2009 Jul;34 Suppl 1:S2-7

Authors: Dryden MS

Skin and soft tissue infections (SSTIs) are common and range in severity from minor, self-limiting, superficial infections to life-threatening diseases requiring all the resources of modern medicine. The classification of SSTIs can be based on the anatomical site, clinical severity or microbial cause, but some classifications divide SSTIs into complicated and uncomplicated infections. Community-acquired SSTIs are most commonly caused by staphylococci or streptococci, but almost any organism is capable of causing inflammation within soft tissue. Recent epidemiological trends have shown an increase not only in healthcare-associated meticillin-resistant Staphylococcus aureus (MRSA), but also in MRSA acquired in the community. Many of the latter strains produce exotoxins and are epidemiologically distinct from healthcare-acquired strains. Factors that may affect the microbial cause include underlying disease such as diabetes or immune dysfunction; hospital attendance, injecting drug use, travel, animal contact and environmental contamination.

PMID: 19560670 [PubMed - indexed for MEDLINE]