title: How to stratify patients at risk for resistant bugs in skin and soft tissue infections?
abstract: OBJECTIVE
  This article describes the strategies for stratifying patients with skin and soft tissue infections (SSTIs) according to their risk for infection with multidrug-resistant (MDR) pathogens.
  
  
  RESULTS
  Methicillin-resistant Staphylococcus aureus (MRSA) now represents the main cause in a variety of serious SSTIs. Risk factors for MRSA are constantly evolving and the distinction between community-acquired MRSA and hospital-acquired MRSA is becoming less clear from a therapeutic standpoint because of overlapping susceptibility patterns. Given these observations, physicians should be aware that directed empirical coverage of MRSA for serious SSTIs should be required in communities where this resistant pathogen is recognized to be a prevalent cause of infection. Similarly, other MDR bacteria are demonstrating alarming trends as causative pathogens in SSTIs. Pseudomonas aeruginosa, Acinetobacter species, and vancomycin-resistant Enterococcus can play an important role in polymicrobial long-standing infections such as diabetic foot infection and decubiti, but are also increasingly recognized in monomicrobial SSTIs.
  
  
  CONCLUSIONS
  SSTIs caused by MDR bacteria, both Gram-positive and Gram-negative bacteria, are on the rise especially in patients with long-standing infections and those with prior antibiotic exposure. Recognition of risk factors for infection with MDR bacteria should assist clinicians in targeting appropriate antibiotic therapy to at-risk individuals.
authors.affiliation: aDivision of Pulmonary, Critical Care, and Sleep Medicine bDivision of Infectious Diseases, University of New Mexico School of Medicine, Albuquerque, New Mexico cDivision of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Cristina Vazquez
authors.initials: CV
authors.lastname: Guillamet
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000150:Acinetobacter / Q000302:isolation & purification; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D018570:Risk Assessment; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000453:epidemiology* / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology*; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification