Background: Complicated skin and skin structure infections (cSSSIs) are among the most common
infections treated in the hospital setting. The mainstays of treatment continue to be antimicrobial
therapy combined with appropriate surgical intervention. Due to increasing resistance
among pathogens commonly implicated in cSSSIs, the objectives of this review were
to describe the potential pathogens causing skin infections, the implications of resistance to
currently used drug therapy, and the role of new antibiotics with activity for pathogens causing
cSSSIs.
Methods: Relevant information from the primary literature and review articles were identified
through a MEDLINE search of the medical literature (1980 to the present) using the
terms abscess, wound infection, skin and skin structure infection, antibiotics, resistance, quinupristin-
dalfopristin, linezolid, daptomycin, tigecycline, oritavancin, and dalbavancin. Meeting
posters and slides were identified from the Interscience Conference of Antimicrobial
Agents and Chemotherapy (1998–2004) for supplemental data.
Results: The most commonly implicated pathogens in cSSSIs include gram-positive bacteria,
specifically Staphylococcus aureus. Gram-negative and mixed organisms are additionally
encountered in serious cSSSI. Antimicrobial resistance among both gram-positive and gramnegative
bacteria has increased significantly during the last decade, with methicillin resistance
among S. aureus approaching 60% in hospitals and becoming more frequent in the community
as well. As a result, resistance is the driving factor for treatment failure and rising
costs for infection management. Few antimicrobial agents are available currently to treat resistant
bacteria in cSSSIs; vancomycin is currently the drug of choice against resistant grampositive
cocci; however, resistance to this agent has appeared in enterococci and S. aureus.
Several new antibiotics such as linezolid and daptomycin are now available for the management
of cSSSIs. Other agents such as tigecycline are under investigation and should be available
soon to increase treatment options for cSSSIs caused by resistant bacteria.
Conclusions: Although the resistance of cSSSI pathogens is problematic, new antibiotics
with broad-spectrum activity against resistant gram-positive and gram-negative bacteria are
promising for the management of severe cSSSIs.
