Skin and soft-tissue infections (SSTIs) or Acute bacterial skin and skin-structure infections (ABSSSIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections.
Two terms are used interchangeably in literature but according to FDA, ABSSSIs include cellulitis/erysipelas, wound infection, and major cutaneous abscess with a minimum lesion surface area of 75 cm 2.
SCOPE OF PROBLEM
Acute bacterial skin and skin structure infections (ABSSSI) are among the most common infections observed in the emergency department. More than 15% of patients who present to the emergency department with an ABSSSI are admitted to the hospital, and the average hospitalization costs per patient range from $6300 to $13,000, with multi day room and board expenses comprising 50% of the total costs of care.
Mortality rate of patients hospitalized for ABSSSI was 0.5%.
TREATMENT GUIDELINES
Infectious Diseases Society of America (IDSA) published practice guidelines for the diagnosis and management of ABSSSIs in 2014. World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E) issued their recommendations in 2018.
Several antibiotics were approved by FDA after publication of the IDSA guidelines, including dalbavancin, oritavancin, tedizolid, and delafloxacin.
SUMMARY OF IDSA GUIDELINES
NEWER ANTIBIOTICS
Following are the newer antibiotics for ABSSSI
| Attribute | Dalbavancin | Oritavancin | Tedizolid | Delafloxacin | LEFAMULIN
|
| Mechanism of action | Bactericidal,
Lipoglycopeptide
long plasma half-life (6–10 days) |
Bactericidal,
Lipoglycopeptide
long elimination half-life |
Oxazolidione antibiotic; action is mediated by binding to the 50S subunit of the bacterial ribosome, resulting in inhibition of protein synthesis | Improved
Cellular transmembrane penetration and potency in acidic environments. Delafloxacin targets both topoisomerase IV and DNA gyrase. Bactericidal
|
Bacteriostatic, Binding to the
peptidyl transferase center of the 50S ribosomal subunit Semisynthetic Pleuromutilin
|
| INDICATIONS | ABSSSI caused by susceptible strains of
gram-positive microorganisms |
ABSSSI caused by susceptible strains of
gram-positive microorganisms |
ABSSSI caused by susceptible strains of
gram-positive microorganisms |
ABSSSI caused by susceptible strains of
gram-positive and gram-negative microorganisms |
ABSSSI caused by susceptible strains of
gram-positive skin pathogens |
| IV form available | Yes | Yes | Yes | Yes | Yes |
| Oral form available | No | No | Yes | Yes | Yes |
| No dosing adjustment | No | No | yes | Yes | ? |
| Common side effect | nausea,
diarrhea, and pruritis |
nausea, headache, and vomiting | Nausea , Headache ,
Diarrhea |
Diarrhea,
Nausea |
Diarrhea,
Vomiting ?
|
| Trial Comparison with | vancomycin followed by oral linezolid | Vancomycin | Linezolid | vancomycin plus aztreonam | vancomycin |
| Dosing | Single-dose regimen: 1500 mg IV over 30 min
Two-dose regimen: 1000 mg IV over 30 min followed 1 week later by 500 mg IV over 30 min |
Single-dose regimen:
1200 mg IV over 3 hours |
200 mg IV/oral tablet
daily for 6 days; IV infusion over 1 hour |
300 mg IV over 60 min every 12 hours for
5–14 days OR 450 mg oral tablet every 12 hours for 5–14 days |
600 mg oral and 150 mg iv |