title: Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review.
abstract: OBJECTIVE
  To review the salient features of the diagnosis and management of the most common skin and soft tissue infections (SSTI). This review focuses on severe SSTIs that require care in an intensive care unit (ICU), including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis.
  
  
  METHODS
  Guidelines, expert opinion, and local institutional policies were reviewed.
  
  
  RESULTS
  Severe SSTIs are common and their management complex due to regional variation in predominant pathogens and antimicrobial resistance patterns, as well as variations in host immune responses. Unique aspects of care for SSTIs in the ICU are discussed, including the role of prosthetic devices, risk factors for bacteremia, and the need for surgical consultation. SSTI mimetics, the role of dermatologic consultation, and the unique features of SSTIs in immunocompromised hosts are also described.
  
  
  CONCLUSIONS
  We provide recommendations for clinicians regarding optimal SSTI management in the ICU setting.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Burnham
authors.affiliation: Division of General Surgery, Acute and Critical Care Surgery Section, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Kirby
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Ave, Campus Box 8052, St. Louis, MO, 63110, USA. kollefm@wustl.edu.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D006801:Humans; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012874:Skin Diseases, Infectious / Q000175:diagnosis* / Q000628:therapy*; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000628:therapy*
keywords: Gas gangrene; Necrotizing fasciitis; Skin and soft tissue infections in the intensive care unit