Management of Soft Tissue Infections

Clinical Presentation and Diagnosis

The presence of at least 2 signs of inflammation, such as pain, warmth, tenderness, and likely erythema, confirms the diagnosis of infection, according to the Diabetes/Metabolism Research and Reviews 1, 3, 4
Increasing pain intensity is a critical red flag that suggests either progression of infection or development of a deep tissue complication, as stated in the Diabetes/Metabolism Research and Reviews and Clinical Infectious Diseases 1, 2

The IWGDF/IDSA guidelines explicitly state that infection with "deep-tissue abscess" represents a moderate (Grade 3) infection that requires surgical consultation and possible drainage, as mentioned in the Diabetes/Metabolism Research and Reviews 1, 4
The American College of Physicians and the Infectious Diseases Society of America recommend immediate reassessment for deep tissue involvement requiring surgical drainage when a patient with soft tissue infection fails to improve or worsens despite antibiotic therapy, according to the Clinical Infectious Diseases 1, 2, 5

When a patient with soft tissue infection fails to improve or worsens despite antibiotic therapy, immediately reassess for deep tissue involvement requiring surgical drainage, adequacy of initial debridement, need for imaging, and vascular compromise, as recommended by the Diabetes/Metabolism Research and Reviews and Clinical Infectious Diseases 1, 2, 5
Surgical drainage is the definitive treatment for abscess, and antibiotics alone will not resolve an infection with undrained purulent collection, as stated in the Diabetes/Metabolism Research and Reviews and Clinical Infectious Diseases 1, 2

Never assume antibiotics alone will resolve an infection with undrained purulent collection, and do not delay surgical consultation when a patient with soft tissue infection shows signs of worsening despite 2-7 days of appropriate antibiotic therapy, as warned by the Diabetes/Metabolism Research and Reviews and Clinical Infectious Diseases 1, 2, 5
Increasing pain is never normal during treatment of infection and mandates immediate reassessment for complications, according to the Diabetes/Metabolism Research and Reviews and Clinical Infectious Diseases 1, 2