Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics

Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics Hoe Nam Leong,1 Asok Kurup,2 Mak Yong Tan,3 Andrea Lay Hoon Kwa,4,5 Kui Hin Liau,6 Mark H Wilcox7 1Rophi Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore; 2Infectious Diseases Care Private Ltd, Mount Elizabeth Medical Centre, Singapore, Singapore; 3My Orthopaedic Clinic, Gleneagles Medical Centre, Singapore, Singapore; 4Department of Pharmacy, Singapore General Hospital, Singapore, Singapore; 5Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore; 6LIAU KH Specialist Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore; 7Department of Medical Microbiology, Leeds Teaching Hospitals and University of Leeds, Leeds, UK Abstract: Complicated skin and soft tissue infections (cSSTIs) represent the severe form of infectious disease that involves deeper soft tissues. Involvement of methicillin-resistant Staphylococcus aureus (MRSA) further complicates cSSTI with increased hospitalization, health care costs, and overall mortality. Various international guidelines provide recommendations on the management of cSSTIs, with the inclusion of newer antibiotics. This literature-based review discusses the overall management of cSSTI, including appropriate use of antibiotics in clinical practice. Successful treatment of cSSTIs starts with early and precise diagnosis, including identification of causative pathogen and its load, determination of infection severity, associated complications, and risk factors. The current standard-of-care for cSSTIs involves incision, drainage, surgical debridement, broad-spectrum antibiotic therapy, and supportive care. In recent years, the emergence of newer antibiotics (eg, ceftaroline, tigecycline, daptomycin, linezolid, etc) has provided clinicians wider options of antimicrobial therapy. Selection of antibiotics should be based on the drug characteristics, effectiveness, safety, and treatment costs, alongside other aspects such as host factors and local multidrug resistance rates. However, larger studies on newer antibiotics are warranted to refine the decision making on the appropriate antimicrobial therapy. Local Antimicrobial Stewardship Program strategies in health care settings could guide clinicians for early initiation of specific treatments to combat region-specific antimicrobial resistance, minimize adverse effects, and to improve outcomes such as reduction in Clostridium difficile infections. These strategies involving iv-to-oral switch, de-escalation to narrow-spectrum antibiotics, and dose optimization have an impact on the overall improvement of cSSTI therapy outcomes, especially in countries like Singapore that has a high disease burden. Keywords: antibiotics, complicated skin and soft tissue infections, methicillin-resistant Staphylococcus aureus, Singapore