Skin and skin structure infections (SSSIs), also referred to as skin and soft tissue infections (SSTIs), [1] or, in the case of acute ones of bacterial cause, acute bacterial skin and skin structure infections (ABSSSIs), [2] are infections of skin and associated soft tissues (such as loose connective tissue and mucous membranes). Historically, the pathogen involved has most frequently been a bacterial species. The newer term ABSSSIs was coined to focus on this main subset specifically, which usually requires treatment by antibiotics.
Until 2008, a distinction was made between two types: complicated SSSIs (cSSSIs) and uncomplicated SSSIs (uSSSIs), [3] which had different regulatory approval requirements. [4] [ needs update ] Uncomplicated SSSIs included "simple abscesses, impetiginous lesions, furuncles, and cellulitis." [4] Complicated SSSIs included "infections either involving deeper soft tissue or requiring significant surgical intervention, such as infected ulcers, burns, and major abscesses or a significant underlying disease state that complicates the response to treatment." [4] The FDA further noted that "[s]uperficial infections or abscesses in an anatomical site, such as the rectal area, where the risk of anaerobic or Gram-negative pathogen involvement is higher, [were also] considered complicated infections." [4] The uncomplicated category (uSSSI) is most frequently caused by Staphylococcus aureus and Streptococcus pyogenes , whereas the complicated category (cSSSI) might also be caused by a number of other pathogens. [4] [ verification needed ] As of 2013, the pathogen involved in cases of cSSSI were known about 40% of the time. [4] [ needs update ][ verification needed ]
As of 2014, physicians were reported as generally not culturing to identify the infecting bacterial pathogen during diagnosis of SSSIs [5]
Common treatment is empirical, with choice of an antibiotic agent based on presenting symptoms and location, and further followup based on trial and error. [5] [ verification needed ] To achieve efficacy against SSSIs, physicians most often use broad-spectrum antibiotics,[ citation needed ] a practice contributing to increasing prevalence of antibiotic resistance,[ citation needed ] a trend related to the widespread use of antibiotics in medicine in general.[ citation needed ] The increased prevalence of antibiotic resistance is evident in MRSA species commonly involved in SSSIs, which worsen prognoses and limit treatment options.[ citation needed ] For less severe infections, microbiologic evaluation using tissue culture has been demonstrated to have high utility in guiding management decisions. [5]
There is no evidence to support or oppose the use of Chinese herbal medicines in treating SSTIs. [6]