Question

Baby S (a 3-month old baby boy) was brought to the clinic by his foster mother. He has been in her care only 24 hours and came with some problems due to lack of care. He has an inflamed bottom near his genitalia and anus. The foster mother states that he has been crying nearly continually since he came to her, and he is very uncomfortable when he urinates. He looks dehydrated as his lips are dry and skin appears dry. She has attempted to put some cream on the bottom, with no effect.

Question: Describe how a skin infection can be differentiated from a systemic infection in terms of the pathophysiology and symptoms. Support your answer using specific facts, data, examples, and other information drawn from the textbook and at least one other supplemental source.

Answer 1

Ans) SSTIs are a highly prevalent but complex and diverse group of infections. As a result of the diversity of their presentation, clinical management is challenging. Furthermore, their management is complicated by the paucity of evidence from well-documented studies, and decisions regarding site of care and appropriate antimicrobial therapy may be inconsistent and inefficient.

- One method of addressing site of care decisions is to determine disease severity based on the combination of several clinical findings. Disease severity should consider location, size, systemic symptoms, comorbidities and significant characteristics of the infection.

- Based on these criteria, SSTIs may be classified as either mild or moderate to severe. Following this stratification, one can determine the site of care: mild lesions can be treated in the outpatient setting with oral therapy, whereas moderate to severe lesions may require hospitalization or outpatient intravenous therapy.

- Appropriate antibiotic therapy is the key to infection treatment. Empirical therapy should depend on several factors: potential pathogens, disease severity, clinical complications and the instrument of entry (eg, animal bite). For all uncomplicated lesions, empirical therapy should target the typical Gram-positive skin flora, such as S pyogenes and S aureus. For lesions below the waist, therapy should also be directed against enteric species.

- Characteristics that complicate SSTIs include prolonged hospitalization and antibiotic therapy, diabetes, rapidly progressive and necrotic lesions, bite wounds, exposure to salt water or freshwater, injection drug use, HIV and risk factors for community-associated MRSA. Empirical therapy for SSTIs in the above settings must include coverage of the commonly encountered pathogens.

- Finally, the duration of therapy and use of oral therapy are best determined by careful follow-up and astute clinical judgement. It is also unknown whether current therapy guidelines for outpatient and hospitalized patient care are optimal with respect to treatment efficacy and health care costs.