[Bacterial skin and soft tissue infections].

Abstract

Skin and soft tissue infections (SSTIs) represent a diverse spectrum of conditions, including erysipelas, cellulitis, cutaneous abscesses, necrotizing fasciitis, and myonecrosis. Erysipelas and cellulitis are the most common community-acquired SSTIs. Erysipelas is typically caused by pyogenic streptococci, while cellulitis often has a staphylococcal etiology. Dia-gnosis of erysipelas and cellulitis is primarily clinical and may be supported by the NEW HAvUN scoring system. Treat-ment is based on the use of narrow-spectrum antibiotics primarily targeting gram-positive bacteria. In the Czech Republic, intramuscular forms of penicillin G (procaine penicillin G for treatment and benzathine penicillin G for prophylaxis) are used for erysipelas in certain situations for historical reasons. For cellulitis, oxacillin, flucloxacillin, or cefazolin are commonly employed. The use of broad-spectrum antibiotics is only justified when an atypical etiology is suspected (including gram-negative or anaerobic bacteria), in high-risk patient groups, or following animal bites or exposure to aquatic environments. The article also lists second-line antibiotics for patients with a beta-lactam allergy. The standard duration of antibiotic therapy should not exceed 10 days, and it is often shorter (five to seven days). In cases of necrotizing fasciitis or myonecrosis, early diagnosis, prompt surgical intervention, intensive care, and antibiotic treatment - typically a combination of a beta-lactam and clindamycin, based on the likely pathogen and entry site - are crucial. The text highlights the importance of sound clinical judgment and appropriate antibiotic use as essential strategies to prevent the overuse of broad-spectrum antibiotics and curb antimicrobial resistance. Keywords: erysipelas, cellulitis, skin abscess, necrotizing fasciitis, myonecrosis.