Identifying patients with difficult-to-treat acute bacterial skin infections.

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2024-04-01 Epub Date: 2023-11-30 DOI:10.1097/QCO.0000000000000991
Philippe Montravers, Romy Soussan, Sébastien Tanaka
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引用次数: 0

Abstract

Purpose of review: The early recognition of acute bacterial skin infections (ABSIs) and their swift and adequate care are the major determinants of success. The features that can hamper or delay surgical and medical management can lead to 'difficult-to-treat' ABSIs.

Recent findings: Delayed diagnosis and belated management are the key obstacles to be overcome. Clinicians should be careful about underestimating the severity of ABSIs and overlooking comorbidities, especially immunosuppression. Many conditions can lead to delayed source control, including a misdiagnosis, interhospital transfers, delayed re-exploration, or extensive injuries. Difficult therapeutic issues can occur, including rapidly destructive infections from highly pathogenic microorganisms (Group-A-streptococci, Vibrio spp., Clostridium spp. and Staphylococcus aureus ) or inadequate antibiotic therapy resulting from multidrug-resistant bacteria. Impaired pharmacokinetic capacities of antibiotic agents should also be considered as a source of clinical failure due to insufficient antimicrobial activity at the site of infection.

Summary: Microbiological samples should be used for guiding antimicrobial therapy. Risk factors for multidrug-resistant bacteria should be considered, including local epidemiology and comorbidities. The optimization of antibiotic therapy should be achieved. Optimized care should be achieved through multidisciplinary management involving professionals with sufficient and appropriate training.

识别难以治疗的急性细菌性皮肤感染患者。
回顾的目的:早期识别急性细菌性皮肤感染(ABSIs)及其迅速和充分的护理是成功的主要决定因素。妨碍或延迟手术和医疗管理的特征可能导致“难以治疗”的ABSIs。最新发现:延迟诊断和延迟治疗是需要克服的主要障碍。临床医生应小心低估ABSIs的严重程度和忽视合并症,特别是免疫抑制。许多情况可能导致源头控制延迟,包括误诊、医院间转院、延迟重新探查或大面积损伤。可能出现困难的治疗问题,包括高致病性微生物(a群链球菌、弧菌、梭菌和金黄色葡萄球菌)造成的快速破坏性感染,或多重耐药细菌导致的抗生素治疗不充分。由于感染部位抗菌活性不足,抗生素药物的药代动力学能力受损也应被视为临床失败的一个原因。总结:微生物样品应用于指导抗菌治疗。应考虑多重耐药细菌的危险因素,包括当地流行病学和合并症。优化抗生素治疗方案。最佳护理应通过多学科管理来实现,专业人员应接受充分和适当的培训。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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