World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections

World Journal of Emergency Surgery, Nov 2014

Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.

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World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections

World Journal of Emergency Surgery World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections Massimo Sartelli 0 1 Mark A Malangoni 1 Addison K May 1 Pierluigi Viale 1 Lillian S Kao 1 Fausto Catena 1 Luca Ansaloni 1 Ernest E Moore 1 Fred A Moore 1 Andrew B Peitzman 1 Raul Coimbra 1 Ari Leppaniemi 1 Yoram Kluger 1 Walter Biffl 1 Kaoru Koike 1 Massimo Girardis 1 Carlos A Ordonez 1 Mario Tavola 1 Miguel Cainzos 1 Salomone Di Saverio 1 Gustavo P Fraga 1 Igor Gerych 1 Michael D Kelly 1 Korhan Taviloglu 1 Imtiaz Wani 1 Sanjay Marwah 1 Miklosh Bala 1 Wagih Ghnnam 1 Nissar Shaikh 1 Osvaldo Chiara 1 Mario Paulo Faro Jr 1 Gerson Alves Pereira Jr 1 3 Carlos Augusto Gomes 1 2 Federico Coccolini 1 Cristian Tran 0 1 Davide Corbella 1 6 Pietro Brambillasca 1 6 Yunfeng Cui 1 7 Helmut A Segovia Lohse 1 4 Vladimir Khokha 1 5 Kenneth YY Kok 1 9 Suk-Kyung Hong 1 10 Kuo-Ching Yuan 1 8 0 Department of Surgery, Macerata Hospital , Via Santa Lucia 2, Macerata 62019 , Italy 1 Emergency Surgery Division, ABC Medical School , Santo Andre, SP , Brazil 2 Hospital Universitario Therezinha de Jesus, Faculdade de Ciencias Medicas e da Saude de Juiz de Fora (SUPREMA), Universidade Federal de Juiz de Fora (UFJF) , Minas Gerais , Brasil 3 Emergency Surgery and trauma Unit, Department of Surgery , Ribeirao, Preto , Brazil 4 II Catedra de Clinica Quirurgica, Hospital de Clinicas, Universidad Nacional de Asuncion , San Lorenzo , Paraguay 5 Department of Surgery, Mozyr City Hospital , Mozyr , Belarus 6 Department of Anestesiology, Papa Giovanni XXIII Hospital , Bergamo , Italy 7 Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University , Tianjin , China 8 Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital , Taipei , Taiwan 9 Department of Surgery, Ripas Hospital , Bandar Seri Begawan , Brunei 10 Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan , Seoul , Republic of Korea Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations. - NSTIs appears to have decreased over the past decade, possibly due to improved recognition and earlier delivery of more effective therapy [2]. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, aggressive resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidenced-based guidelines for management of soft tissue infections. The guidelines outline clinical recommendations based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) hierarchy criteria summarized in Table 1 [3,4]. Surgical site infections 1) Surgical site infections require prompt and wide opening of the surgical incision. Antimicrobial therapy is recommended for deep incisional surgical site infections if systemic signs of sepsis are present, if source Table 1 Grading of recommendations from Guyatt and colleagues [3,4] Uncertainty in the estimates of benefits, risks, and burden; benefits, risk, and burden may be closely balanced control is incomplete or in immunocompromised patients (Recommendation 1 C). 2) In patients who have had clean operations, anti microbial therapy should cover gram-positive organisms; in contrast, in patients who have had procedures on the gastrointestinal or genitourinary tract antimicrobial therapy should cover both gram-positive and gram-negative organisms (Recommendation 1 C). Non necrotizing superficial soft tissue infections 3) Erysipelas, and cellulitis are managed by antimicrobial therapy against Gram-positive bacteria (Recommendation 1 C). 4) Lack of clinical response for cellulitis may be due to resistant strains of staphylococcus or streptococcus, or deeper processes, such as necrotizing fasciitis or myonecrosis (Recommendation 1 C). 5) Therapy for community-acquired MRSA should be recommended for patients at risk for CA-MRSA or who do not respond to beta-lactam therapy within 48 to 72 hours (Recommendation 1 C). 6) If a streptococcal toxic shock syndrome is suspected, an antiribosomal agent such as clindamycin or Quality of supporting (...truncated)


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Massimo Sartelli, Mark A Malangoni, Addison K May, Pierluigi Viale, Lillian S Kao, Fausto Catena, Luca Ansaloni, Ernest E Moore, Fred A Moore, Andrew B Peitzman, Raul Coimbra, Ari Leppaniemi, Yoram Kluger, Walter Biffl, Kaoru Koike, Massimo Girardis, Carlos A Ordonez, Mario Tavola, Miguel Cainzos, Salomone Di Saverio, Gustavo P Fraga, Igor Gerych, Michael D Kelly, Korhan Taviloglu, Imtiaz Wani, Sanjay Marwah, Miklosh Bala, Wagih Ghnnam, Nissar Shaikh, Osvaldo Chiara, Mario Faro Jr, Gerson Pereira Jr, Carlos Gomes, Federico Coccolini, Cristian Tranà, Davide Corbella, Pietro Brambillasca, Yunfeng Cui, Helmut A Segovia Lohse, Vladimir Khokha, Kenneth YY Kok, Suk-Kyung Hong, Kuo-Ching Yuan. World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections, World Journal of Emergency Surgery, 2014, pp. 57, 9, DOI: 10.1186/1749-7922-9-57