Complicated and suppurative skin soft tissue infections: our four-year cases

Abstract

Skin and soft tissue infections (SSTIs) are common community and hospital-acquired infections and rarely result in severe morbidity and mortality. It is not always possible to obtain cultures and isolate the causative agent in these patients, primarily treated with empirical antibiotics. In this retrospective cross-sectional study, 57 patients with complicated SSTI followed between 2018 and 2022 with purulent and necrotizing characteristics or growth in blood cultures were included. Thirty-eight patients (66.7%) were male, and 39 (68.4) had diabetes. In 43 (75.5%) patients, the infection was in the lower extremity and gluteal region. Gram-positive agents were detected in 35 patients (61.4%), Gram-negative agents were found in 13 patients (22.8%), and Gram-positive and Gram-negative mixed growth was detected in 1 patient (1.8%), and no causative agent could be produced in 8 (14%) patients. Of the 21 Staphylococcus aureus produced, 4 (19%) were methicillin-resistant (MRSA). Growth was detected in blood cultures in three patients (5.3%), and all were streptococcal bacteria. It was observed that 31 patients (54.4%) required hospitalization for treatment, and 29 (50.8%) required surgical intervention such as drainage, aspiration, debridement, or amputation. Three patients (5.3%) died, and four (7%) underwent amputation. There was no significant difference between diabetic and non-diabetic patients regarding factors and mortality–morbidity. In the logistic regression analysis, none of the variables of gender, type of causative agent, presence of diabetes, and site of infection significantly affected severe morbidity and mortality. Since it was detected at a low rate in our cases, it can be said that MRSA and P.aeruginosa do not need to be considered in every patient for the initial empirical treatment, Gram-negative rods can be taken into account, especially in diabetics, and broad-spectrum and combined antibiotics are not needed in the vast majority of patients. Microbiological follow-up and sensitivity studies at regional and global scales will need to continue to guide empirical treatments in SSTIs.