In the critical care setting the clinician is faced with two major categories of skin
and soft tissue infection. The first is extensive, severe, and often necrotizing infection;
the second is the atypical or unusual infection that may be misdiagnosed, resulting
in delayed treatment. The recent rise in the frequency of transplant surgery, advances
in cancer chemotherapy, and an increase in the incidence of HIV infection have resulted
in greater numbers of immunocompromised patients at risk for skin and soft tissue
infections in both these categories. Diabetes mellitus also is a major underlying
risk factor for developing extensive infections of the skin and soft tissues.
A thorough understanding of the various etiologies and presentations of these infections
is essential in the critical care setting; it is also important to discriminate between
infectious and noninfectious causes of skin and soft tissue inflammation. Drug-induced
skin changes such as toxic epidermal necrolysis (TEN) may be quite severe and can
lead to significant morbidity and mortality. A detailed history and physical are necessary
to narrow the possible etiologies of infection. In many cases surface cultures are
unreliable and often misleading because surface-colonizing organisms can be mistaken
for pathogens. In instances in which the diagnosis is in doubt, aspiration, biopsy,
or surgical exploration of the skin lesion should be considered.
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Article info
Footnotes
Address reprint requests to Charles V. Sanders, MD, Edgar Hull Professor and Chairman, Department of Medicine, LSU School of Medicine, New Orleans, LA 70112–2822
Identification
Copyright
© 1998 W. B. Saunders Company. Published by Elsevier Inc. All rights reserved.
