Treatment of complicated skin and soft-tissue infections caused by resistant bacteria: value of linezolid, tigecycline,
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554 Eur J Med Res (2010) 15: 554-563
november 30, 2010 © I. Holzapfel Publishers 2010
TREaTMEnT of CoMPlICaTEd SkIn and SofT-TISSuE InfECTIonS CauSEd by RESISTanT baCTERIa: ValuE of lInEzolId, TIgECyClInE, daPToMyCIn and VanCoMyCIn Christian Eckmann1 and Matthew dryden 2 1klinikum
Peine, academic Hospital of Medical university Hannover, germany Hampshire Hospital, Winchester, united kingdom
2 Royal
Abstract antibiotic-resistant organisms causing both hospitaland community-acquired complicated skin and softtissue infections (cSSTI) are increasingly reported. a substantial medical and economical burden associated with MRSa colonisation or infection has been documented. The number of currently available appropriate antimicrobial agents is limited. good quality randomised, controlled clinical trial data on antibiotic efficacy and safety is available for cSSTI caused by MRSa. linezolid, tigecycline, daptomycin and vancomycin showed efficacy and safety in MRSa-caused cSSTI. none of these drugs showed significant superiority in terms of clinical cure and eradication rates.To date, linezolid offers by far the greatest number of patients included in controlled trials with a strong tendency of superiority over vancomycin in terms of eradication and clinical success.. Tigecycline is an alternative in polymicrobial infections except by diabetic foot infections. daptomycin might be a treatment option for cases of cSSTI with MRSa bacteremia. cSSTI caused by resistant gramnegative bacteria are a matter of great concern. The development of new antibiotics in this area is an urgent priority to avoid the risk of a postantibiotic era with no antimicrobial treatment options. an individual approach for every single patient is mandatory to evaluate the optimal antimicrobial treatment regimen.
InTRoduCTIon Skin and soft tissue infections (SSTI) are amongst the most common bacterial infections in humans. They represent one of the most common indications for antibiotic treatment and represent about 10% of hospital admissions in the uS [1]. amongst the broad spectrum of skin and soft tissue infections treatment is mainly delivered out of hospital. SSTI have a broad range of aetiology, clinical manifestation and severity [2, 3]. at one end of the spectrum the outcome may be spontaneous resolution without antibiotics, but at the other end it may present with sepsis with lethal outcome. SSTI at 10% is the third most frequent focus for severe sepsis or septic shock, after pneumonia (5560%) and abdominal infections (25%) [4].
This review aims to discuss the currently available antibiotics active against resistant bacteria (primarily MRSa, VRE, ESbl-producing bacteria and carbapenem-resistant strains) in terms of mechanisms of action, eradication rates and most important clinical outcome.
ClaSSIfICaTIon of SkIn and SofT TISSuE InfECTIonS The classification of skin and soft tissue infections is often confusing. Specific SSTI can be sub-categorised according to the causative microbial agents, the main tissue layer affected (i.e. skin, subcu
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