Cellulitis, infected wounds, abscesses, and other bacterial infections of skin and soft tissue account for a significant number of clinical visits to the dermatology, medicine, family practice, and pediatric clinics as well as emergency rooms worldwide. Before physicians in the many different countries can treat these infections, they must have a means of determining the causative bacteria. In the case of a primary bacterial infection produced by the invasion of normal skin by a single species of pathogenic bacteria, most infections will be due to Gram-positive organisms. Secondary infections develop in areas of already damaged skin and the infecting bacteria invasion and proliferation aggravate the underlying condition and prolong the disease. In contrast to the primary infections, secondary infections demonstrate multiple organisms including Gram-positive organisms, but Gram-negative organisms are not infrequently seen on culture. The majority of these infections are mild to moderate in severity and can be treated with either topical or oral medication. The etiological agents as shown in Table 45.1 vary little worldwide with Streptococcus pyogenes (Group A streptococcus) and Staphylococcus aureus accounting for greater than 90% of all skin infections. Even in those areas of the world where more exotic pathogens exist, the majority of infections are still caused by staphylococcus and streptococcus. This would suggest that treatment recommendations in any country would apply to all other countries.
KeywordsPenicillin Staphylococcus Acne Clostridium Fluoroquinolone
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