Why Are Complicated Soft Skin and Tissue Infections a Problem?

Why Should You Be Interested in Complicated Soft Skin and Tissue Infections (cSSTI)?

Complicated skin and soft-tissue infections (cSSTIs) occur frequently and comprise a broad range of clinical presentations. Postoperative surgical site infections (SSI) represent up to 25% of all nosocomial infections and about 15% of diabetic patients will develop foot infections.  cSSTIs are common in persons with diabetes and are typically more difficult to treat than those without diabetes.  Despite the frequent occurrence of these infections, there is a lack of consensus on how to best treat these infections.  

Why Do Public Health Workers Care? 

Despite the frequent occurrence of these infections, there is a limited understanding of several aspects of cSSTIs as well as a general lack of consensus on how to best treat these infections.  Very few studies have explored the current clinical practices of cSSTIs and their related outcomes.  This is of particular concern with the expansion of Medicaid and it is necessary to study the factors that influence the clinical and patient-perceived outcomes of cSSTIs.

If They’re So Common, Why Is This An Issue?

Some think that the lack of validated standardized tools that guide the clinical management and treatment of cSSTIs results in compromised patient and clinical outcomes and increased cSSTI prevalence rates.

Can You Explain This Issue?  Where Did You Get That Idea From?

This is based on 4 observations. 

1. First, there are different classification measures for cSSTIs, none of which are validated.  cSSTIs can be classified according to the anatomical site of infection, microbial etiology, or severity.  Classifications are designed to alert the provider to the level and type of care needed for treatment.
2. Second, the knowledge of the epidemiology and susceptibility of pathogens (which are needed to guide the selection of antibiotics) are often unknown.  Coupled with the increased prevalence of multidrug resistant pathogens (e.g.: methicillin-resistant Staphylococcus aureus (MRSA), etc.), has further complicated the development of guidelines for treatment. 
3. Third, the fundamental source of these issues may lie in the US Food and Drug Administration’s (FDA) definition of cSSTIs. Coined in 1998, it is to serve as a guide for industry in designing clinical trials that would include similar groups of infections.  It was not to provide a clinical framework for the treatment of cSSTIs. 
4. Fourth, cSSTIs are common in persons with diabetes and are typically more difficult to treat than those without diabetes.

Ok, I am Scared/Worried/Concerned.  What Can I do?

Well, there is not much you can really do except adhere to the prescribed treatment that your provider gives you. 

You can also try to prevent such infections, especially diabetic foot infections.  Here is a site to offer some help with prevention (by the American Family Physician and another easy to read one here).

You can also help write to our legislators (find yours here) to help create standardized lists, kind of like surgical checklists.

WE ARE PUBLIC HEALTH

What are your thoughts?