EDITORIAL URRENT C OPINION
Developments in skin and soft tissue infection Matthew S. Dryden
Years may wrinkle the skin, but to give up enthusiasm wrinkles the soul. Samuel Ullman The issue covers developments in the management of skin and soft tissue infection. The new acronym for soft tissue infection, coined by those who regulate clinical trials in USA, is ABSSSI, that is, acute bacterial skin and skin structure infections. The skin and its underlying structures are the largest organ in the body and as this organ presents a protective barrier to the external environment, ABSSSI is very common and one of the main reasons for antibiotic use. The clinical spectrum of ABSSSI is very wide, ranging from mild self-limiting inflammation to life-threatening infection. The causes of infection in skin are very varied – viruses, bacteria, fungi, protozoa and helminths, and in addition there are many skin manifestations of systemic infection. Although beauty is only skin deep, skin changes reflect holistic health! Staphylococci remain predominant amongst bacterial causes of ABSSSI and their epidemiology is in regular upheaval. The global trend in staphylococcal epidemiology is towards increasing resistance and increasing pathogenicity. Methicillin resistance is no longer a healthcare-associated problem, and in many parts of the world multiple resistant staphylococci are the commonest cause of ABSSSI. In this issue, we hear about the challenges in assessing methicillin resistance and determining toxicity. A further review looks at the pathogenic mechanisms of group A streptococcal (GAS) infection, another major bacterial pathogen of soft tissue and one which causes a wide spectrum of clinical presentation. This helps understand how this organism causes disease and is relevant in the light of new guidelines (in the UK at least) for the management
of invasive GAS disease and the identification of outbreaks and their control. Two studies discuss the limitations of old antibiotics to treat ABSSSI and the development of novel agents for clinical use. Antibiotic development and discovery is limited. This is the reason that national and global campaigns such as Antibiotic Action by the British Society for Antimicrobial Chemotherapy and the 10’20 initiative of the Infectious Diseases Society of America are important to increase awareness amongst governments, the public, academic institutions and the pharmaceutical industry of the dearth of new antimicrobials, and to encourage co-operation in their development. Antibiotic resistance may be the biggest threat to global health and the development of medicine, and despite much discussion there has been little change in prescribing habits worldwide. Part of antibiotic stewardship is recognizing when antibiotics are unnecessary and can be avoided. A review discusses topical treatments and antiseptics for skin lesions that require some local antimicrobial support but do not require systemic antibiotics. This should aid the management of skin lesions that require topical care rather than systemic antibiotics. Finally, a review examines atypical causes of soft tissue infection by mycobacteria, which are notable for their difficulty in diagnosis because they need to be thought about and also because of their resistance to conventional treatment. Acknowledgements None. Conflicts of interest There are no conflicts of interest.
Correspondence to Matthew S. Dryden, Series Editor, Hampshire Hospitals, Winchester, Hampshire SO22 5DG, UK. E-mail: matthew. [email protected]
Curr Opin Infect Dis 2014, 27:115 DOI:10.1097/QCO.0000000000000051 0951-7375 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
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