Infectious Diseases Society of America Issues Update of Skin and Soft Tissue Infections Guidelines

By on 12:45 PM

Methicillin resistant Staphylococcus aureus (MRSA) continues to increase exponentially nationwide. While strides have been taken and results are showing that healthcare facility rates are slowly declining, outpatient skin and soft tissue infections (SSTIs) resulting from this organism continue to be identified in emergency rooms and doctor' offices.

Emergency room visits for SSTIs have shown a dramatic increase over a 10-year period, almost tripling in numbers between 1995 and 2005. SSTIs have resulted in millions of visits to private doctors' offices and clinics. MRSA infections range from mild infections, which do not require antibiotics but are treated by incising and draining (I&D) of the lesion, to fatal cases of necrotizing fasciitis, also known as "flesh-eating" bacteria.

The challenge for physicians in the outpatient setting relates to whether to treat SSTIs that are presumably a result of MRSA with antibiotics or whether to perform an I&D of the lesion. Due to the vast range of "illnesses" that can occur as a result of this organism, an educated, and clinically sound decision needs to be made with each individual case.

The Infectious Diseases Society of America (IDSA) issued guidelines for the diagnosis and management of SSTIs in 2005, and just released an update to the guidelines (pdf) in June. The update was developed as a result of the exponential increase in MRSA SSTIs. The guidelines contain a chart to help physicians with diagnoses and prompt treatment of SSTIs based on purulence (which is prominent in MRSA cases) and classification of the infection (mild, moderate or severe).

SSTI patients who present with fevers above 100.4, tachycardia (increased heart rate over baseline), leukocytosis (increased white blood cells denoting infection) and/or an increase in rate of breathing are the most concerning, and the guidelines address specific treatment steps. The guidelines also provide guidance for immunocompromised patients as they are a specific challenge beyond the immunocompetent patient who presents with a skin lesion suggestive of MRSA.

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.