How to stratify patients at risk for resistant bugs in skin and soft tissue infections?

PURPOSE OF REVIEW: This article describes the strategies for stratifying patients with skin and soft tissue infections (SSTIs) according to their risk for infection with multidrug-resistant (MDR) pathogens.

RECENT FINDINGS: Methicillin-resistant Staphylococcus aureus (MRSA) now represents the main cause in a variety of serious SSTIs. Risk factors for MRSA are constantly evolving and the distinction between community-acquired MRSA and hospital-acquired MRSA is becoming less clear from a therapeutic standpoint because of overlapping susceptibility patterns. Given these observations, physicians should be aware that directed empirical coverage of MRSA for serious SSTIs should be required in communities where this resistant pathogen is recognized to be a prevalent cause of infection. Similarly, other MDR bacteria are demonstrating alarming trends as causative pathogens in SSTIs. Pseudomonas aeruginosa, Acinetobacter species, and vancomycin-resistant Enterococcus can play an important role in polymicrobial long-standing infections such as diabetic foot infection and decubiti, but are also increasingly recognized in monomicrobial SSTIs.

SUMMARY: SSTIs caused by MDR bacteria, both Gram-positive and Gram-negative bacteria, are on the rise especially in patients with long-standing infections and those with prior antibiotic exposure. Recognition of risk factors for infection with MDR bacteria should assist clinicians in targeting appropriate antibiotic therapy to at-risk individuals.