Cellulitis and Soft Tissue Infections Author: Dennis L. Stevens, PhD, MD; Lawrence J. Eron, MD, FACP
Editorial changes - 2009-11-03
Author information and module status
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up

Tables
Figures
References
Glossary
What's New
Patient Information
Additional Resources
Tools
References
1. 3Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee. Society for Healthcare Epidemiology of America. Association for Professionals in Infection Control. Infectious Diseases Society of America. Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol. 2002;23(12 Suppl):S3-40. (PMID: 12515399)
2. 2Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al; SHEA. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003;24:362-86. (PMID: 12785411)
3. 3Bootsma MC, Diekmann O, Bonten MJ. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci U S A. 2006;103:5620-5. (PMID: 16565219)
4. 3Karchmer TB, Durbin LJ, Simonton BM, Farr BM. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect. 2002;51:126-32. (PMID: 12090800)
5. 2Robicsek A, Beaumont JL, Paule SM, Hacek DM, Thomson RB Jr, Kaul KL, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med. 2008;148:409-18. (PMID: 18347349) [Full Text]
6. 2 Jeyaratnam D, Whitty CJ, Phillips K, Liu D, Orezzi C, Ajoku U, et al. Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial. BMJ. 2008;336:927-30. (PMID: 18417521)
7. 2Calfee DP, Durbin LJ, Germanson TP, Toney DM, Smith EB, Farr BM. Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA. Infect Control Hosp Epidemiol. 2003;24:422-6. (PMID: 12828318)
8. 3Daum RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007;357:380-90. (PMID: 17652653)
9. 2Hota B, Ellenbogen C, Hayden MK, Aroutcheva A, Rice TW, Weinstein RA. Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections at a public hospital: do public housing and incarceration amplify transmission? Arch Intern Med. 2007;167:1026-33. (PMID: 17533205)
10. 2Diep BA, Chambers HF, Graber CJ, Szumowski JD, Miller LG, Han LL, et al. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Intern Med. 2008;148:249-57. (PMID: 18283202) [Full Text]
11. 1Ellis MW, Griffith ME, Dooley DP, McLean JC, Jorgensen JH, Patterson JE, et al. Targeted intranasal mupirocin to prevent colonization and infection by community-associated methicillin-resistant Staphylococcus aureus strains in soldiers: a cluster randomized controlled trial. Antimicrob Agents Chemother. 2007;51:3591-8. (PMID: 17682105)
12. 2Holtom PD. Antibiotic prophylaxis: current recommendations. J Am Acad Orthop Surg. 2006;14(10 Suppl):S98-S100. (PMID: 17003220)
13. 3Hilmarsdottir I, Valsdottir F. Molecular typing of Beta-hemolytic streptococci from two patients with lower-limb cellulitis: identical isolates from toe web and blood specimens. J Clin Microbiol. 2007;45:3131-2. (PMID: 17609319)
14. 1Parish LC, Jorizzo JL, Breton JJ, Hirman JW, Scangarella NE, Shawar RM, et al; SB275833/032 Study Team. Topical retapamulin ointment (1%, wt/wt) twice daily for 5 days versus oral cephalexin twice daily for 10 days in the treatment of secondarily infected dermatitis: results of a randomized controlled trial. J Am Acad Dermatol. 2006;55:1003-13. (PMID: 17097398)
15. 1Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al; Infectious Diseases Society of America. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885-910. (PMID: 15472838)
16. 1Lipsky BA, Holroyd KJ, Zasloff M. Topical versus systemic antimicrobial therapy for treating mildly infected diabetic foot ulcers: a randomized, controlled, double-blinded, multicenter trial of pexiganan cream. Clin Infect Dis. 2008;47:1537-45. (PMID: 18990064)
17. 2Semel JD, Goldin H. Association of athlete's foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples. Clin Infect Dis. 1996;23:1162-4. (PMID: 8922818)
18. 1Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001;(2):CD001738. (PMID: 11406003)
19. 1Talan DA, Abrahamian FM, Moran GJ, Citron DM, Tan JO, Goldstein EJ; Emergency Medicine Human Bite Infection Study Group. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis. 2003;37:1481-9. (PMID: 14614671)
20. 2Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med. 1999;340:85-92. (PMID: 9887159)
21. 1Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;41:1373-406. (PMID: 16231249)
22. 3Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250-78. (PMID: 10219875)
23. 1Webster J, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. 2007;(2):CD004985. (PMID: 17443562)
24. 3Robicsek A, Beaumont JL, Peterson LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2009;48:910-3. (PMID: 19231982)
25. 1Simor AE, Phillips E, McGeer A, Konvalinka A, Loeb M, Devlin HR, et al. Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis. 2007;44:178-85. (PMID: 17173213)
26. 1Ellis MW, Hospenthal DR, Dooley DP, Gray PJ, Murray CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis. 2004;39:971-9. (PMID: 15472848)
27. 2Ellis MW, Griffith ME, Jorgensen JH, Hospenthal DR, Mende K, Patterson JE. Presence and molecular epidemiology of virulence factors in methicillin-resistant Staphylococcus aureus strains colonizing and infecting soldiers. J Clin Microbiol. 2009;47:940-5. (PMID: 19213694)
28. 1Bradley SF. Eradication or decolonization of methicillin-resistant Staphylococcus aureus carriage: what are we doing and why are we doing it? Clin Infect Dis. 2007;44:186-9. (PMID: 17173214)
29. 1Ammerlaan HS, Kluytmans JA, Wertheim HF, Nouwen JL, Bonten MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis. 2009;48:922-30. (PMID: 19231978)
30. 2Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005;5:751-62. (PMID: 16310147)
31. 2Wertheim HF, Vos MC, Ott A, van Belkum A, Voss A, Kluytmans JA, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004;364:703-5. (PMID: 15325835)
32. 1Bieber L, Kahlmeter G. Staphylococcus lugdunensis in several niches of the normal skin flora. Clin Microbiol Infect. 2009 Jun 6 [Epub ahead of print]. (PMID: 19519842)
33. 2Eron LJ, Lipsky BA, Low DE, Nathwani D, Tice AD, Volturo GA; Expert panel on managing skin and soft tissue infections. Managing skin and soft tissue infections: expert panel recommendations on key decision points. J Antimicrob Chemother. 2003;52 Suppl 1:i3-17. (PMID: 14662806)
34. 2Bisno AL, Cockerill FR 3rd, Bermudez CT. The initial outpatient-physician encounter in group A streptococcal necrotizing fasciitis. Clin Infect Dis. 2000;31:607-8. (PMID: 10987730)
35. 2Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44:705-10. (PMID: 17278065)
36. 3Busch BA, Ahern MT, Topinka M, Jenkins JJ 2nd, Weiser MA. Eschar with cellulitis as a clinical predictor in community-acquired MRSA skin abscess. J Emerg Med. 2008 Jul 8 [Epub ahead of print]. (PMID: 18614328)
37. 1Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34:730-51. (PMID: 11850858)
38. 3NCCN practice guidelines for fever and neutropenia. National Comprehensive Cancer Network. Oncology (Williston Park). 1999;13(5A):197-257. (PMID: 10370929)
39. 2Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, et al. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med. 1989;321:1-7. (PMID: 2659990)
40. 2Eron LJ, Lipsky BA. Use of cultures in cellulitis: when, how, and why? Eur J Clin Microbiol Infect Dis. 2006;25:615-7.(PMID: 16896821)
41. 1Eriksson B, Jorup-Rönström C, Karkkonen K, Sjöblom AC, Holm SE. Erysipelas: clinical and bacteriologic spectrum and serological aspects. Clin Infect Dis. 1996;23:1091-8. (PMID: 8922808)
42. 2Kaplan EL, Anthony BF, Chapman SS, Ayoub EM, Wannamaker LW. The influence of the site of infection on the immune response to group A streptococci. J Clin Invest. 1970;49:1405-14.(PMID: 5432372)
43. 2Bisno AL, Nelson KE, Waytz P, Brunt J. Factors influencing serum antibody responses in streptococcal pyoderma. J Lab Clin Med. 1973;81:410-20. (PMID: 4686957)
44. 2Zahar JR, Goveia J, Lesprit P, Brun-Buisson C. Severe soft tissue infections of the extremities in patients admitted to an intensive care unit. Clin Microbiol Infect. 2005;11:79-82. (PMID: 15649312)
45. 3Arslan A, Pierre-Jerome C, Borthne A. Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis. Eur J Radiol. 2000;36:139-43. (PMID: 11091013)
46. 2Parenti GC, Marri C, Calandra G, Morisi C, Zabberoni W. [Necrotizing fasciitis of soft tissues: role of diagnostic imaging and review of the literature]. Radiol Med (Torino). 2000;99:334-9. (PMID: 10938701)
47. 2Zittergruen M, Grose C. Magnetic resonance imaging for early diagnosis of necrotizing fasciitis. Pediatr Emerg Care. 1993;9:26-8. (PMID: 8488141)
48. 3Ramirez-Schrempp D, Dorfman DH, Baker WE, Liteplo AS. Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain? Pediatr Emerg Care. 2009;25:44-8. (PMID: 19148015)
49. 2Miller LG, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352:1445-53. (PMID: 15814880)
50. 2Terebelo HR, McCue RL, Lenneville MS. Implication of plasma free hemoglobin in massive clostridial hemolysis. JAMA. 1982;248:2028-9. (PMID: 6288977)
51. 2Beltran J. MR imaging of soft-tissue infection. Magn Reson Imaging Clin N Am. 1995;3:743-51. (PMID: 8564693)
52. 2Fisher JR, Conway MJ, Takeshita RT, Sandoval MR. Necrotizing fasciitis. Importance of roentgenographic studies for soft-tissue gas. JAMA. 1979;241:803-6. (PMID: 762845)
53. 1Sivitz AB, Lam SH, Ramirez-Schrempp D, Valente JH, Nagdev AD. Effect of bedside ultrasound on management of pediatric soft-tissue infection. J Emerg Med. 2009 Aug 7 [Epub ahead of print]. (PMID: 19665335)
54. 2Kuo YL, Shieh SJ, Chiu HY, Lee JW. Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. Eur J Clin Microbiol Infect Dis. 2007;26:785-92. (PMID: 17674061)
55. 3Sunshine JH, Lewis RS, Bhargavan M. A portrait of interventional radiologists in the United States. AJR Am J Roentgenol. 2005;185:1103-12. (PMID: 16247117)
56. 2Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis. 1992;14:2-11. (PMID: 1571429)
57. 2Jahamy H, Ganga R, Raiy BA, Shemes S, Nagappan V, Sharma M, et al. Staphylococcus aureus skin/soft-tissue infections: The impact of SCCmec type and Panton-Valentine leukocidin. Scand J Infect Dis. 2008:1-7. (PMID: 18609230)
58. 2Dall L, Peddicord T, Peterson S. Hospitalist treatment of CAP and cellulitis using objective criteria to select patients. Infect Med. 2003;20:379-99.
59. 2Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med. 1996;334:240-5. (PMID: 8532002)
60. 2Schrock JW, Laskey S, Cydulka RK. Predicting observation unit treatment failures in patients with skin and soft tissue infections. Int J Emerg Med. 2008;1:85-90. (PMID: 19384657)
61. 2Eron L, King P, Marineau M, Yonehara C. Treating acute infections by telemedicine in the home. Clin Infect Dis. 2004;39:1175-81. (PMID: 15486842)
62. 2Fine MJ, Singer DE, Marrie TH. Medical outcomes of ambulatory and hospitalized low risk patients with community-acquired pneumonia. J Gen Intern Med. 1994;9 (suppl 2):29.
63. 2Eron LJ, Passos S. Early discharge of infected patients through appropriate antibiotic use. Arch Intern Med. 2001;161:61-5. (PMID: 11146699)
64. 2Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, et al. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis [serial on the Internet]. 2009;15(9). Available at: http://www.cdc.gov/EID/content/15/9/1516.htm
65. 1Corwin P, Toop L, McGeoch G, Than M, Wynn-Thomas S, Wells JE, et al. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. BMJ. 2005;330:129. (PMID: 15604157)
66. 2Hoffman-Terry ML, Fraimow HS, Fox TR, Swift BG, Wolf JE. Adverse effects of outpatient parenteral antibiotic therapy. Am J Med. 1999;106:44-9. (PMID: 10320116)
67. 1Tice AD, Rehm SJ, Dalovisio JR, Bradley JS, Martinelli LP, Graham DR, Gainer RB, Kunkel MJ, Yancey RW, Williams DN; IDSA. Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines. Clin Infect Dis. 2004;38:1651-72. (PMID: 15227610)
68. 1Labarere J, Stone RA, Obrosky DS, Yealy DM, Meehan TP, Fine JM, et al. Comparison of outcomes for low-risk outpatients and inpatients with pneumonia: A propensity-adjusted analysis. Chest. 2007;131:480-8. (PMID: 17296651)
69. 2Nathwani D, Tice A. Ambulatory antimicrobial use: the value of an outcomes registry. J Antimicrob Chemother. 2002;49:149-54. (PMID: 11751779)
70. 2Chambers S, Gallagher K, Metcalf S, Pithie A. Home intravenous antimicrobial service—twelve months experience in Christchurch. N Z Med J. 2002;115:216-8. (PMID: 12064707)
71. 1Armstrong DG, Lavery LA; Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet. 2005;366:1704-10. (PMID: 16291063)
72. 1Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy utilizing vacuum-assisted closure to advanced moist wound therapy in the treatment of diabetic foot ulcers a multicenter randomized controlled trial. Diabetes Care. 2008;31:631-6. (PMID: 18162494)
73. 2Kranke P, Bennett M, Roeckl-Wiedmann I, Debus S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2004;(2):CD004123. (PMID: 15106239)
74. 2George ME, Rueth NM, Skarda DE, Chipman JG, Quickel RR, Beilman GJ. Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect (Larchmt). 2009;10:21-8. (PMID: 18991520)
75. 2Barnes RC. Point: hyperbaric oxygen is beneficial for diabetic foot wounds. Clin Infect Dis. 2006;43:188-92. (PMID: 16779745)
76. 2Berendt AR. Counterpoint: hyperbaric oxygen for diabetic foot wounds is not effective. Clin Infect Dis. 2006;43:193-8. (PMID: 16779746)
77. 1Lee MC, Rios AM, Aten MF, Mejias A, Cavuoti D, McCracken GH Jr, et al. Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J. 2004;23:123-7. (PMID: 14872177)
78. 2Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al; EMERGEncy ID Net Study Group. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666-74. (PMID: 16914702)
79. 2Ruhe JJ, Menon A. Tetracyclines as an oral treatment option for patients with community onset skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2007;51:3298-303. (PMID: 17576834)
80. 1Duong M, Markwell S, Peter J, Barenkamp S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med. 2009 Apr 29 [Epub ahead of print]. (PMID: 19409657)
81. 2Madaras-Kelly KJ, Remington RE, Oliphant CM, Sloan KL, Bearden DT. Efficacy of oral beta-lactam versus non-beta-lactam treatment of uncomplicated cellulitis. Am J Med. 2008;121:419-25. (PMID: 18456038)
82. 1Bergkvist PI, Sjobeck K. Antibiotic and prednisolone therapy of erysipelas: a randomized, double blind, placebo-controlled study. Scand J Infect Dis. 1997;29:377-82. (PMID: 9360253)
83. 1Bergkvist PI, Sjobeck K. Relapse of erysipelas following treatment with prednisolone or placebo in addition to antibiotics: a 1-year follow-up. Scand J Infect Dis. 1998;30:206-7. (PMID: 9730318)
84. 2Dall L, Peterson S, Simmons T, Dall A. Rapid resolution of cellulitis in patients managed with combination antibiotic and anti-inflammatory therapy. Cutis. 2005;75:177-80. (PMID: 15839362)
85. 2Spellberg B, Talbot GH, Boucher HW, Bradley JS, Gilbert D, Scheld WM, et al. Antimicrobial agents for complicated skin and skin-structure infections: justification of noninferiority margins in the absence of placebo-controlled trials. Clin Infect Dis. 2009;49:383-91. (PMID: 19555285)
86. 1Dillon HC Jr. Treatment of staphylococcal skin infections: a comparison of cephalexin and dicloxacillin. J Am Acad Dermatol. 1983;8:177-81. (PMID: 6826814)
87. 2Madaras-Kelly KJ, Arbogast R, Jue S. Increased therapeutic failure for cephalexin versus comparator antibiotics in the treatment of uncomplicated outpatient cellulitis. Pharmacotherapy. 2000;20:199-205. (PMID: 10678298)
88. 1Stevens DL, Smith LG, Bruss JB, McConnell-Martin MA, Duvall SE, Todd WM, et al. Randomized comparison of linezolid (PNU-100766) versus oxacillin-dicloxacillin for treatment of complicated skin and soft tissue infections. Antimicrob Agents Chemother. 2000;44:3408-13. (PMID: 11083648)
89. 1Kremer M, Zuckerman R, Avraham Z, Raz R. Long-term antimicrobial therapy in the prevention of recurrent soft-tissue infections. J Infect. 1991;22:37-40. (PMID: 2002231)
90. 1Kasseroller R. Sodium selenite as prophylaxis against erysipelas in secondary lymphedema. Anticancer Res. 1998;18:2227-30. (PMID: 9703790)
91. 2Lawrence KR, Golik MV, Davidson L. The role of primary care prescribers in the diagnosis and management of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Am J Ther. 2009;16:333-8. (PMID: 19617720)
92. 2Ruhe JJ, Smith N, Bradsher RW, Menon A. Community-onset methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: impact of antimicrobial therapy on outcome. Clin Infect Dis. 2007;44:777-84. (PMID: 17304447)
93. 2Iyer S, Jones DH. Community-acquired methicillin-resistant Staphylococcus aureus skin infection: a retrospective analysis of clinical presentation and treatment of a local outbreak. J Am Acad Dermatol. 2004;50:854-8. (PMID: 15153884)
94. 1Markowitz N, Quinn EL, Saravolatz LD. Trimethoprim-sulfamethoxazole compared with vancomycin for the treatment of Staphylococcus aureus infection. Ann Intern Med. 1992;117:390-8. (PMID: 1503330)
95. 2Martinez-Aguilar G, Hammerman WA, Mason EO Jr, Kaplan SL. Clindamycin treatment of invasive infections caused by community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus in children. Pediatr Infect Dis J. 2003;22:593-8. (PMID: 12867833)
96. 2Ruhe JJ, Monson T, Bradsher RW, Menon A. Use of long-acting tetracyclines for methicillin-resistant Staphylococcus aureus infections: case series and review of the literature. Clin Infect Dis. 2005;40:1429-34. (PMID: 15844065)
97. 2Hersh AL, Weintrub PS, Cabana MD. Antibiotic selection for purulent skin and soft-tissue infections in ambulatory care: a decision-analytic approach. Acad Pediatr. 2009;9:179-84. (PMID: 19450778)
98. 3Levy RM, Huang EY, Roling D, Leyden JJ, Margolis DJ. Effect of antibiotics on the oropharyngeal flora in patients with acne. Arch Dermatol. 2003;139:467-71. (PMID: 12707094)
99. 1Cenizal MJ, Skiest D, Luber S, Bedimo R, Davis P, Fox P, et al. Prospective randomized trial of empiric therapy with trimethoprim-sulfamethoxazole or doxycycline for outpatient skin and soft tissue infections in an area of high prevalence of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2007;51:2628-30. (PMID: 17502411)
100. 1Stevens DL, Herr D, Lampiris H, Hunt JL, Batts DH, Hafkin B. Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. 2002;34:1481-90. (PMID: 12015695)
101. 2Davis SL, McKinnon PS, Hall LM, Delgado G Jr, Rose W, Wilson RF, et al. Daptomycin versus vancomycin for complicated skin and skin structure infections: clinical and economic outcomes. Pharmacotherapy. 2007;27:1611-8. (PMID: 18041881)
102. 2Davis SL, Perri MB, Donabedian SM, Manierski C, Singh A, Vager D, et al. Epidemiology and outcomes of community-associated methicillin-resistant Staphylococcus aureus infection. J Clin Microbiol. 2007 Jun;45(6):1705-11. (PMID: 17392441)
103. 3Das B, Sarkar C, Biswas R, Pandey S. Review: dalbavancin—a novel lipoglycopeptide antimicrobial for gram positive pathogens. Pak J Pharm Sci. 2008;21:78-87.(PMID: 18166524)
104. 3Billeter M, Zervos MJ, Chen AY, Dalovisio JR, Kurukularatne C. Dalbavancin: a novel once-weekly lipoglycopeptide antibiotic. Clin Infect Dis. 2008;46:577-83. (PMID: 18199045)
105. 1Jauregui LE, Babazadeh S, Seltzer E, Goldberg L, Krievins D, Frederick M, et al. Randomized, double-blind comparison of once-weekly dalbavancin versus twice-daily linezolid therapy for the treatment of complicated skin and skin structure infections. Clin Infect Dis. 2005;41:1407-15. (PMID: 16231250)
106. 3Crandon J, Nicolau DP. Oritavancin: a potential weapon in the battle against serious Gram-positive pathogens. Future Microbiol. 2008;3:251-63. (PMID: 18505390)
107. 1Li Z, Willke RJ, Pinto LA, Rittenhouse BE, Rybak MJ, Pleil AM, et al. Comparison of length of hospital stay for patients with known or suspected methicillin-resistant Staphylococcus species infections treated with linezolid or vancomycin: a randomized, multicenter trial. Pharmacotherapy. 2001;21:263-74. (PMID: 11256381)
108. 2McKinnon PS, Carter CT, Girase PG, Liu LZ, Carmeli Y. The economic effect of oral linezolid versus intravenous vancomycin in the outpatient setting: the payer perspective. Manag Care Interface. 2007;20:23-34. (PMID: 17310650)
109. 2McCollum M, Sorensen SV, Liu LZ. A comparison of costs and hospital length of stay associated with intravenous/oral linezolid or intravenous vancomycin treatment of complicated skin and soft-tissue infections caused by suspected or confirmed methicillin-resistant Staphylococcus aureus in elderly US patients. Clin Ther. 2007;29:469-77. (PMID: 17577468)
110. 2Schürmann D, Sorensen SV, De Cock E, Duttagupta S, Resch A. Cost-effectiveness of linezolid versus vancomycin for hospitalised patients with complicated skin and soft-tissue infections in Germany. Eur J Health Econ. 2009;10:65-79. (PMID: 18437437)
111. 2De Cock E, Sorensen S, Levrat F, Besnier JM, Dupon M, Guery B, et al. Cost-effectiveness of linezolid versus vancomycin for hospitalized patients with complicated skin and soft-tissue infections in France. Med Mal Infect. 2009;39:330-40. (PMID: 19304423)
112. 2Bounthavong M, Hsu DI, Okamoto MP. Cost-effectiveness analysis of linezolid vs. vancomycin in treating methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections using a decision analytic model. Int J Clin Pract. 2009;63:376-86. (PMID: 19222624)
113. 1Krige JE, Lindfield K, Friedrich L, Otradovec C, Martone WJ, Katz DE, et al. Effectiveness and duration of daptomycin therapy in resolving clinical symptoms in the treatment of complicated skin and skin structure infections. Curr Med Res Opin. 2007;23:2147-56. (PMID: 17669231)
114. 2Pertel PE, Eisenstein BI, Link AS, Donfrid B, Biermann EJ, Bernardo P, et al. The efficacy and safety of daptomycin vs. vancomycin for the treatment of cellulitis and erysipelas. Int J Clin Pract. 2009;63:368-75. (PMID: 19222623)
115. 2Laohavaleeson S, Kuti JL, Nicolau DP. Telavancin: a novel lipoglycopeptide for serious gram-positive infections. Expert Opin Investig Drugs. 2007;16:347-57. (PMID: 17302529)
116. 1Stryjewski ME, Graham DR, Wilson SE, O'Riordan W, Young D, Lentnek A, et al. Telavancin versus vancomycin for the treatment of complicated skin and skin-structure infections caused by gram-positive organisms. Clin Infect Dis. 2008;46:1683-93. (PMID: 18444791)
117. 1Noel GJ, Strauss RS, Amsler K, Heep M, Pypstra R, Solomkin JS. Results of a double-blind, randomized trial of ceftobiprole treatment of complicated skin and skin structure infections caused by gram-positive bacteria. Antimicrob Agents Chemother. 2008;52:37-44. (PMID: 17954698)
118. 1Talbot GH, Thye D, Das A, Ge Y. Phase 2 study of ceftaroline versus standard therapy in treatment of complicated skin and skin structure infections. Antimicrob Agents Chemother. 2007;51:3612-6. (PMID: 17682094)
119. 1Noel GJ, Bush K, Bagchi P, Ianus J, Strauss RS. A randomized, double-blind trial comparing ceftobiprole medocaril with vancomycin plus ceftazidime for the treatment of patients with complicated skin and skin-structure infections. Clin Infect Dis. 2008;46:647-55. (PMID: 18225981)
120. 2Bogdanovich T, Ednie LM, Shapiro S, Appelbaum PC. Antistaphylococcal activity of ceftobiprole, a new broad-spectrum cephalosporin. Antimicrob Agents Chemother. 2005;49:4210-9. (PMID: 16189100)
121. 1Gentry LO, Ramirez-Ronda CH, Rodriguez-Noriega E, Thadepalli H, del Rosal PL, Ramirez C. Oral ciprofloxacin vs parenteral cefotaxime in the treatment of difficult skin and skin structure infections. A multicenter trial. Arch Intern Med. 1989;149:2579-83. (PMID: 2684078)
122. 2Stevens DL. Streptococcal toxic shock syndrome associated with necrotizing fasciitis. Annu Rev Med. 2000;51:271-88. (PMID: 10774464)
123. 2Freischlag JA, Ajalat G, Busuttil RW. Treatment of necrotizing soft tissue infections. The need for a new approach. Am J Surg. 1985;149:751-5. (PMID: 4014552)
124. 2Stevens DL, Gibbons AE, Bergstrom R, Winn V. The Eagle effect revisited: efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. J Infect Dis. 1988;158:23-8. (PMID: 3292661)
125. 2Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J. 1999;18:1096-100. (PMID: 10608632)
126. 2Mulla ZD, Leaverton PE, Wiersma ST. Invasive group A streptococcal infections in Florida. South Med J. 2003;96:968-73. (PMID: 14570340)
127. 2Stevens DL, Bryant AE, Hackett SP. Antibiotic effects on bacterial viability, toxin production, and host response. Clin Infect Dis. 1995;20 Suppl 2:S154-7. (PMID: 7548539)
128. 3Merino Díaz L, Torres Sánchez MJ, Aznar Martín J. Prevalence and mechanisms of erythromycin and clindamycin resistance in clinical isolates of beta-haemolytic streptococci of Lancefield groups A, B, C and G in Seville, Spain. Clin Microbiol Infect. 2008;14:85-7. (PMID: 18034859)
129. 2Stevens DL, Wallace RJ, Hamilton SM, Bryant AE. Successful treatment of staphylococcal toxic shock syndrome with linezolid: a case report and in vitro evaluation of the production of toxic shock syndrome toxin type 1 in the presence of antibiotics. Clin Infect Dis. 2006;42:729-30. (PMID: 16447124)
130. 3Altemeier WA, Fullen WD. Prevention and treatment of gas gangrene. JAMA. 1971 Aug 9;217(6):806-13.(PMID: 5109333)
131. 2Stevens DL, Bryant AE, Adams K, Mader JT. Evaluation of therapy with hyperbaric oxygen for experimental infection with Clostridium perfringens. Clin Infect Dis. 1993;17:231-7. (PMID: 8399871)
132. 2Stevens DL. Dilemmas in the treatment of invasive Streptococcus pyogenes infections. Clin Infect Dis. 2003;37:341-3. (PMID: 12884157)
133. 2Kaul R, McGeer A, Norrby-Teglund A, Kotb M, Schwartz B, O'Rourke K, et al. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome—a comparative observational study. The Canadian Streptococcal Study Group. Clin Infect Dis. 1999;28:800-7. (PMID: 10825042)
134. 1Darenberg J, Ihendyane N, Sjolin J, Aufwerber E, Haidl S, Follin P, et al; StreptIg Study Group. Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2003;37:333-40. (PMID: 12884156)
135. 3Bland CM, Frizzi JD, Reyes A. Use of drotrecogin alfa in necrotizing fasciitis: a case report and pharmacologic review. J Intensive Care Med. 2008;23:342-6. (PMID: 18805858)
136. 3Hecht DW. Routine anaerobic blood cultures: back where we started? Clin Infect Dis. 2007 Apr 1;44(7):901-3. (PMID: 17342638)
137. 2Goldstein EJ. Bite wounds and infection. Clin Infect Dis. 1992;14:633-8. (PMID: 1562653)
138. 2Goldstein EJ, Reinhardt JF, Murray PM, Finegold SM. Outpatient therapy of bite wounds. Demographic data, bacteriology, and a prospective, randomized trial of amoxicillin/clavulanic acid versus penicillin +/- dicloxacillin. Int J Dermatol. 1987;26:123-7. (PMID: 3106248)
139. 1Bass JW, Chan DS, Creamer KM, Thompson MW, Malone FJ, Becker TM, et al. Comparison of oral cephalexin, topical mupirocin and topical bacitracin for treatment of impetigo. Pediatr Infect Dis J. 1997;16:708-10. (PMID: 9239775)
140. 1Demidovich CW, Wittler RR, Ruff ME, Bass JW, Browning WC. Impetigo. Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies. Am J Dis Child. 1990;144:1313-5. (PMID: 2244610)
141. 1Tan JS, Wishnow RM, Talan DA, Duncanson FP, Norden CW. Treatment of hospitalized patients with complicated skin and skin structure infections: double-blind, randomized, multicenter study of piperacillin-tazobactam versus ticarcillin-clavulanate. The Piperacillin/Tazobactam Skin and Skin Structure Study Group. Antimicrob Agents Chemother. 1993;37:1580-6. (PMID: 8215266)
142. 1Gentry LO. Treatment of skin, skin structure, bone, and joint infections with ceftazidime. Am J Med. 1985;79:67-74. (PMID: 3895921)
143. 1Paul M, Silbiger I, Grozinsky S, Soares-Weiser K, Leibovici L. Beta lactam antibiotic monotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev. 2006;(1):CD003344. (PMID: 16437452)
144. 1Harbarth S, Nobre V, Pittet D. Does antibiotic selection impact patient outcome? Clin Infect Dis. 2007;44:87-93. (PMID: 17143822)
145. 1Bliziotis IA, Samonis G, Vardakas KZ, Chrysanthopoulou S, Falagas ME. Effect of aminoglycoside and beta-lactam combination therapy versus beta-lactam monotherapy on the emergence of antimicrobial resistance: a meta-analysis of randomized, controlled trials. Clin Infect Dis. 2005;41:149-58. (PMID: 15983909)
146. 3Paterson DL. Impact of antibiotic resistance in gram-negative bacilli on empirical and definitive antibiotic therapy. Clin Infect Dis. 2008;47 Suppl 1:S14-20. (PMID: 18713045)
147. 2Lodise TP Jr, Lomaestro B, Drusano GL. Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Clin Infect Dis. 2007;44:357-63. (PMID: 17205441)
148. 3Fritsche TR, Stilwell MG, Jones RN. Antimicrobial activity of doripenem (S-4661): a global surveillance report (2003). Clin Microbiol Infect. 2005;11:974-84. (PMID: 16307551)
149. 1Chastre J, Wunderink R, Prokocimer P, Lee M, Kaniga K, Friedland I. Efficacy and safety of intravenous infusion of doripenem versus imipenem in ventilator-associated pneumonia: a multicenter, randomized study. Crit Care Med. 2008;36:1089-96. (PMID: 18379232)
150. 2Lorente L, Lorenzo L, Martín MM, Jiménez A, Mora ML. Meropenem by continuous versus intermittent infusion in ventilator-associated pneumonia due to gram-negative bacilli. Ann Pharmacother. 2006;40:219-23. (PMID: 16449546)
151. 2Elting LS, Bodey GP, Keefe BH. Septicemia and shock syndrome due to viridans streptococci: a case-control study of predisposing factors. Clin Infect Dis. 1992;14:1201-7. (PMID: 1623076)
152. 3Tsai YH, Huang TJ, Hsu RW, Weng YJ, Hsu WH, Huang KC, et al. Necrotizing soft-tissue infections and primary sepsis caused by Vibrio vulnificus and Vibrio cholerae non-O1. J Trauma. 2009;66:899-905.(PMID: 19276771)
153. 1Weigelt J, Itani K, Stevens D, Lau W, Dryden M, Knirsch C; Linezolid CSSTI Study Group. Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antimicrob Agents Chemother. 2005;49:2260-6. (PMID: 15917519)
154. 1Hepburn MJ, Dooley DP, Skidmore PJ, Ellis MW, Starnes WF, Hasewinkle WC. Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis. Arch Intern Med. 2004;164:1669-74. (PMID: 15302637)
155. 2Hayward G, Thompson M, Heneghan C, Perera R, Del Mar C, Glasziou P. Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. BMJ. 2009;339:b2976. (PMID: 19661138)
156. 2van Rijen M, Bonten M, Wenzel R, Kluytmans J. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database Syst Rev. 2008:CD006216. (PMID: 18843708)
157. 3Simor AE, Stuart TL, Louie L, Watt C, Ofner-Agostini M, Gravel D, et al; Canadian Nosocomial Infection Surveillance Program. Mupirocin-resistant, methicillin-resistant Staphylococcus aureus strains in Canadian hospitals. Antimicrob Agents Chemother. 2007;51:3880-6. (PMID: 17724154)
158. 2Homer-Vanniasinkam S. Treatment of intra-abdominal and skin and soft tissue infections: The role of the glycylcyclines. Int J Surg. 2006;4:45-52. (PMID: 17462313)
159. 2Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis. 1999;29:60-6. (PMID: 10433566)
160. 1Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159-77. (PMID: 17173212)
161. 1Dupuy A, Benchikhi H, Roujeau JC, Bernard P, Vaillant L, Chosidow O, et al. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ. 1999;318:1591-4. (PMID: 10364117)
162. 3Bristow IR, Spruce MC. Fungal foot infection, cellulitis and diabetes: a review. Diabet Med. 2009;26:548-51.
New References of Interest
163. Lucet JC, Paoletti X, Demontpion C, Degrave M, Vanjak D, Vincent C, et al. Carriage of methicillin-resistant Staphylococcus aureus in home care settings: prevalence, duration, and transmission to household members. Arch Intern Med. 2009;169:1372-8. (PMID: 19667299)
FAQs
Dennis L. Stevens, PhD, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lawrence J. Eron, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.


The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP. Because all PIER modules are updated regularly, printed web pages or PDFs may rapidly become obsolete. Therefore, PIER users should compare the date of the last update on the website with any printout to ensure that the information being referred to is the most current available.
PIER is copyrighted (c) 2009 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.