Management of Skin and Soft-Tissue Infections in Urgent Care (Infectious Disease CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: July 2023 (Volume 2, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 07/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease and 1 Pharmacology CME credits, subject to your state and institutional requirements.

Editor-in-Chief & Update Author

Peer Reviewers

Charting & Coding Author

Abstract

Skin and soft-tissue infections (SSTIs) are common presentations in ambulatory settings. This review describes the varied etiologies and patient presentations of the more common SSTIs: cellulitis, abscesses, and necrotizing soft-tissue infections. A discussion of the common diagnoses masquerading as SSTIs is presented, as well as a stepwise approach to avoiding misdiagnosis. The utility of diagnostic studies such as ultrasound are also discussed. This review also provides an evidence-based analysis of the controversies in management of abscesses, including the commonly utilized techniques of incision and drainage, irrigation, packing, and concurrent antibiotic therapy.

Case Presentations

A 35-year-old man presents with a circular, slightly raised, 4-cm “spider bite” on his left lower leg that has associated warmth, erythema, tenderness, and fluctuance...

• The patient reports that the lesion appeared 2 days ago, and that he has had similar-appearing lesions in the past; he doesn’t actually recall a spider bite.
• He is afebrile and hemodynamically stable, but he states that the area is fairly painful.
• You are concerned for an abscess and plan to perform I&D. What, if any, additional tests or therapies are necessary?

A 32-year-old woman presents with a tender, swollen, erythematous area of her left arm at the level of the antecubital fossa...

• Chart review confirms your suspicion of IV drug use, and the patient admits that she “shoots up” heroin on a near daily basis.
• She denies ever sharing needles, and does not wish to pursue testing for blood-borne pathogens.
• The patient is afebrile and slightly hypertensive, but otherwise has normal vital signs and a nontoxic appearance.
• The area of fluctuance is about 6 cm in diameter and is surrounded by 8-10 cm of oval-shaped erythema.
• Does this patient need ED evaluation, or can she be managed in the urgent care setting? Are blood and wound cultures necessary in this case?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.