What is the management of skin-related bacteremia?

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Last updated: February 11, 2025 • View editorial policy

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From the Guidelines

Skin-related bacteremia management involves prompt initiation of broad-spectrum antibiotics and consideration of surgical intervention for drainage and/or debridement, particularly in complicated cases.

Classification of Skin and Soft-Tissue Infections (SSTIs)

The management of skin-related bacteremia, which can arise from skin and soft-tissue infections (SSTIs), depends on the classification and severity of the infection. SSTIs can be classified into uncomplicated and complicated categories, with the latter requiring more aggressive treatment due to the high risk of life-threatening infection 1.

  • Uncomplicated SSTIs include superficial infections such as cellulitis, simple abscesses, impetigo, and furuncles, which can be treated with empiric antibiotic therapy or simple surgical drainage.
  • Complicated SSTIs involve deeper infections, such as necrotizing infections, infected ulcers, and major abscesses, necessitating broad-spectrum antibiotics and significant surgical intervention.

Management Approach

The Infectious Diseases Society of America (IDSA) guidelines divide infections by purulence, severity, and tissue necrosis, guiding the management approach 1. For non-necrotizing infections, antibiotic therapy is the mainstay of treatment, while necrotizing infections require prompt surgical debridement in addition to antibiotics. The US FDA's definition of acute bacterial skin and skin-structure infection (ABSSSI) helps in identifying complicated soft-tissue infections that require more intensive treatment.

Key Considerations

In managing skin-related bacteremia, it is crucial to assess the infection's severity, the patient's clinical condition, and the need for surgical intervention, as outlined in the 2018 WSES/SIS-E consensus conference recommendations 1. This approach ensures that patients receive appropriate and timely treatment, reducing the risk of complications and improving outcomes.

From the Research

Management of Skin-Related Bacteremia

The management of skin-related bacteremia involves several key components, including:

  • Identification of complicated bacteremia and eradicating foci of infection 2
  • Prolonged antimicrobial therapy for many cases 2
  • A thorough assessment of the incidence and prevalence of skin and soft tissue infections (SSTI) 3
  • Classification of SSTI according to various criteria, such as severity and depth of infection 3

Diagnostic Approach

The diagnosis of SSTI requires:

  • An extended clinical history 3
  • A thorough physical examination 3
  • A high index of suspicion 3
  • Laboratory studies, diagnostic imaging, and surgical exploration in complicated infections 3

Treatment Approach

The treatment of SSTI should conform to:

  • The epidemiology of the infection 3
  • The aetiology of the infection 3
  • The severity and depth of the infection 3
  • Topical, oral, or systemic antimicrobial therapy 3
  • Drainage or debridement as necessary 3
  • Treatment of underlying diseases 3

Antibiotic Therapy

The duration of antibiotic treatment for bloodstream infections, including those caused by skin-related bacteremia, is an area of ongoing research 4

  • A randomised clinical trial is currently underway to compare the effectiveness of 7-day versus 14-day antibiotic treatment for bloodstream infections 4
  • The selection of specific antibiotics, doses, and route of delivery should be left to the discretion of treating physicians 4

Transitions of Care

The management of acute bacterial skin and skin structure infections (ABSSSI) requires a multifaceted approach, including:

  • The use of observation units (OU) and Outpatient Parental Antibiotic Therapy (OPAT) 5
  • The development of new antibiotics for the treatment of skin infections caused by Gram-positive bacteria 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Bacteremia, Sepsis, and Infective Endocarditis Associated with Staphylococcus aureus.

Current topics in microbiology and immunology, 2017

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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