Charles Pollack, M.D.

ABSSSI and Antimicrobial Therapy

Meeting the imperative to deliver efficient health care not only demands that we recognize and treat individual patients; we must also define strategies to optimize patient flow and resource utilization. Acute bacterial skin and skin structure infections (ABSSSI) have become a challenging medical problem associated with high direct and indirect costs to both the medical system and society. Infections due to bacteria with resistance to previously effective antimicrobials such as methicillin-resistant Staphylococcus aureus (MRSA) are increasing in incidence and have led to higher rates of complications and hospitalizations. MRSA has emerged as the most common cause of purulent infections in the United States and many other regions.

In 2013, to identify more clearly a severe subset of skin and soft tissue infections (SSTI) that would typically be treated with parenteral antibiotic therapy, the United States (US) Food and Drug Administration (FDA) issued guidance that standardized the nomenclature to be used in the evaluation of new antimicrobial treatments for complicated SSTI (cSSTI), which are now referred to as acute bacterial skin and skin structure infections, or ABSSSIs. The rationale for developing this terminology was to provide a consistent means of identifying infections for which a reliable drug treatment effect can be estimated. The agents to be studied under the new definition are most often administered parenterally, and patient level of illness is reflected in parameters such as lesion size, leukocytosis, fever, and systemic inflammatory response syndrome.

The specific verbiage from the FDA is as follows: ABSSSIs include cellulitis/erysipelas, wound infection, and major cutaneous abscess with a minimum lesion surface area of 75 cm2. Diabetic foot ulcers and burn wound infections are excluded. Bacterial pathogens that commonly cause ABSSSI include Streptococcus pyogenes and Staphylococcus aureus, including MRSA strains. Less commonly identified bacteria include other Streptococcus species, Enterococcus faecalis, and Gram-negative bacteria.

Why ABSSSI and MRSA are high-priority infections:

  • MRSA is prevalent in ABSSSI.
  • Rates of MRSA infection and hospitalizations are dramatically increasing.
  • MRSA and ASSSI have high rates of morbidity and other associated medical conditions.
  • MRSA infection is a risk factor for subsequent hospitalization and death.
  • Inadequate treatment of MRSA ABSSSI due to antibiotic resistance is likely a factor in relapse.
  • Urgent need exists to reduce hospitalization through the use of more effective outpatient treatment strategies.
  • Effective outpatient management can reduce cost and improve patient outcomes and satisfaction.

This page is a living resource for new and exciting developments in ABSSI and antimicrobial therapy. We will primarily focus on antibiotics and antimicrobial stewardship. Please feel free to submit entries both to catch us up and to keep us current. This is a multidisciplinary, truly interprofessional issue.

Questions or Comments about ABSSSI?