Skin and Soft Tissue Infection (SSTI)

Note

All dosages assume normal renal and hepatic function

Blood cultures should be collected to assist in identification of a causative pathogen

Supportive measure such as limb elevation are important for rapid resolution of swelling

Streamline definitive therapy based on antimicrobial susceptibility testing results

Definitions

Critically Ill

Persistent hypotension
Unexplained metabolic acidosis
ICU admission
qSOFA score ≥2

Severely Immunocompromised

Recent chemotherapy
Neutropenia
Transplant recipient
Treatment with high dose steroids or other immunosuppressive medications

Non-Critically Ill/Immunocompetent

Critically Ill/Severely Immunocompromised

Penicillin Allergy

Patients with penicillin allergy should not receive nafcillin or piperacillin/tazobactam

Patients with minor penicillin allergies

Non-specific rashes, GI intolerances, etc.
Cross reactivity with 3rd and 4th generation cephalosporins is low (<3%)

Critically ill patients

The benefit form beta-lactam antibiotics may outweigh the potential risk

More Information

References

Recommendations are modified from the Infectious Disease Society of America (IDSA) 2014 SSTI Management Guidelines

1) Stevens DL, Bisno AL, Chambers HF, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014;59:e10-52.
2) Pichichero ME. Cephalosporins can be prescribed safely for penicillin-allergic patients. J Fam Pract 2006;55:106-112