Soft tissue infections are common. The clinical spectrum includes
infections of skin, subcutaneous tissue, and of deeper structures such as fascia and muscles. The pathogenesis of these
infections is quite variable. Introduction of microorganisms through skin breaks or through
trauma of other soft tissue is usually at the origin of such
infections. Staphylococci, especially S. aureus, as well as streptococci, mainly group A streptococci cause most
soft tissue infections. In immunocompromised patients or in particuluar circumstances gram-negative bacteria may also be found to cause such
infections. Occasionally,
infections are polymicrobial. Given the predominance of gram-positive cocci, betalactam
antibiotics with good antistaphylococcal activity are the drugs of choice for empiric treatment.
Penicillins or
cephalosporins that are stable against
penicillinase should be chosen, since many staphylococci produce
penicillinase. Over the course of the last 40 years staphylococci first became resistant against
penicillin, and later developed resistance against
methicillin. Methicillin-resistant S. aureus (MRSA) is now a significant problem worldwide. There continue to be major differences in the prevalence of MRSA between geographic regions. In areas with a high prevalence of methicillin resistance among S. aureus, empiric treatment of life-threatening
soft tissue infections should include treatment with a
glycopeptide (i.e.
vancomycin or
teicoplanin). New
antibiotics such as
oxazolidinones (i.e.
linezolid) or
quinupristin/dalfopristin are interesting alternatives to the
glycopeptides in the treatment of
soft tissue infections.