Bacterial infections of the skin and soft tissues are common clinical conditions encountered in infectious disease practice and are a frequent reason for prescribing antibiotics. These infections range from simple superficial skin infections (cellulitis, erysipelas, impetigo, etc.) to serious conditions such as necrotizing infections that require medical treatment with parenteral antibiotics, sometimes under intensive care supervision, following surgical intervention. In general terms, uncomplicated skin and soft tissue infections are those that respond to simple, single-agent antibiotic therapy or simple drainage.

Uncomplicated skin and soft tissue infections

  • Superficial: Impetigo, ecthyma
  • Deep: Erysipelas, cellulitis
  • Hair follicle-related: Folliculitis, furuncle
  • Abscess: Carbuncle and other cutaneous abscesses

Complicated skin and soft tissue infections are defined as infections that invade deep tissues, require specific surgical intervention, and are complicated by an underlying systemic disease. These infections include complicated abscesses, infected burn wounds, infected ulcers, diabetic infections, and deep cavity wound infections. Soft tissue infections requiring surgical intervention, excluding minor cellulitis at the incision site, include both complicated skin and soft tissue infections and necrotizing soft tissue infections. The definition of necrotizing soft tissue infections includes poorly perfused tissue or necrotic tissue pathophysiology. Necrotizing infections are serious infections that cause progressive tissue destruction, lead to significant soft tissue and limb loss, and can result in death.

Complicated skin and soft tissue infections

  • Infections secondary to skin diseases
  • Acute infections
    • Traumatic
    • Bite-related
    • Postoperative
  • Chronic infections
    • Diabetic foot infections
    • Infections secondary to venous stasis ulcers
    • Infections secondary to pressure ulcers
  • Perianal cellulitis ± abscess
  • Necrotizing fasciitis
    • Polymicrobial fasciitis (Type I)
      • Fournier's gangrene
      • Synergistic necrotizing cellulitis with fasciitis and myonecrosis
    • Streptococcal gangrene (Type II)
    • Fasciitis associated with V. vulnificus and other vibrio species
  • Myonecrosis
    • Crepitant myonecrosis
      • Clostridial myonecrosis
        • Traumatic gas gangrene
        • Non-traumatic gas gangrene
    • Synergistic necrotizing cellulitis with fasciitis and myonecrosis
    • Non-crepitant myonecrosis
      • Streptococcal gangrene with myonecrosis

Conscious and appropriate antibiotic use is particularly important in skin and soft tissue infections. Not every antibiotic may be sufficient for the treatment of these infections and may cause the condition to prolong or even progress. Therefore, it is very important for those with these infections to consult an Infectious Diseases and Clinical Microbiology specialist for antibiotic treatment.