Staphylococcal infections of the skin and soft tissues

Becker K., Sunderkötter C.

Abstract

The epidemiological dynamics of Staphylococcus aureus challenge the diagnostics and therapy of skin and soft tissue infections (SSTIs). SSTIs caused by S. aureus range in severity from minor, superficial infections to highly acute, life-threatening diseases requiring immediate therapeutic action. While SSTIs are usually characterized by an acute course of infection, the small colony variant (SCV) phenotype of S. aureus has been associated with chronic and relapsing SSTIs. The diagnostics and therapy of this phenotype necessitates special diagnostic procedures and adapted antibiotic treatment. The still high prevalence of MRSA isolates in Germany limits therapeutic options and requires enormous prevention efforts. In addition to healthcare-related MRSA clonal lineages, the emergence of community-associated (CA-) and livestock-associated (LA-) MRSA is further aggravating the epidemiological situation. Moreover, CA-MRSA are usually characterized by the possession of the Panton-Valentine-Leukozidins (PVL) that is partly responsible for their enhanced virulence. Agricultural livestock is the main animal reservoir for LA-MRSA found in particular in areas with high density of pig farming. They are often zoonotically transmitted from animals to human beings by direct contact. Agents of the beta-lactam antibiotic class (penicil-linase-stable penicillins and first- and second-generation cephalosporins) should be used for the treatment of infections caused by oxacillin-susceptible staphylococcal strains. Vancomycin and the agents of the newer antibiotic classes such as (oxazolidinones, lipopeptides, glycylcyclines and anti-MRSA cephalosporins) are suitable options for the therapy of MRSA infections.