SSTIs: Exploring Aetiology, Pathophysiology, Types and Approaches to Management

Skin and soft tissue infections (SSTIs) are prevalent and vary in intensity, spanning from minor, self-limiting, surface-level infections to severe conditions that pose a threat to life and necessitate the full spectrum of modern medical resources. This chapter undertakes a thorough investigation into SSTIs, delving into their origins, diverse clinical presentations, and the strategies employed in their management. The categorization of SSTIs can hinge on factors such as anatomical site, clinical severity, or microbial origin; nevertheless, certain classifications delineate SSTIs into the division of complicated and uncomplicated infections. Diverse in origin, SSTIs involve the contribution of bacterial, viral, and fungal agents. Conventional culprits such as Staphylococcus aureus (S. aureus) and β-hemolytic streptococci now share the stage with newly identified pathogens, contributing to a complex and nuanced fabric of causative agents. In recent years, community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has ascended to prominence as a significant pathogenic factor in the landscape of SSTIs. This complexity is further heightened by factors like compromised immunity and exposure to environmental elements. The spectrum of clinical presentations extends from localized inflammatory reactions such as erythema, increased warmth, swelling, and pain to severe systemic manifestations like fever, hypotension, and tachycardia, emphasizing the need for a timely and accurate diagnostic assessment. The essence of managing SSTIs is explored, with emphasis placed on the prudent administration of antibiotics, surgical interventions, and careful wound care practices. Antibiotics are necessary for abscesses with widespread cellulitis, rapid progression, or inadequate response to initial drainage, particularly in vulnerable populations or specific anatomical areas. Hospitalization is needed for patients with persistent infections or intolerance to oral antibiotics, especially in severe cases, unstable comorbidities, signs of systemic sepsis, or those requiring surgical intervention. It is essential to distinguish necrotizing infections from non-necrotizing infections to ensure the efficacy of surgical interventions.