Skin and soft tissue infections – from theory to practicey

This paper analyzes current treatment concept for skin and soft tissue infections, moving from theoretical microbiological aspects to specific practical recommendations. It focuses on the concept of rational topical treatment as a key element in the management of patients with purulent-inflammatory processes. The authors substantiates the need for a differentiated approach to the selection of topical antibacterial agents based on the stage of the wound healing process and the specific nature of antibiotic resistance.

The article critically examines the applicability of antimicrobial susceptibility interpretation criteria, originally developed for systemic antibiotics, to topical antimicrobial agents. As an alternative approach for topical antibiotics, the use of epidemiological cut off values (ECOFFs) is proposed, enabling the identification of the wild type strain population, defined as isolates lacking acquired resistance mechanisms to the antibiotic under consideration. The authors emphasize that the high antibiotic concentrations achieved directly at the site of infection through topical application render conventional therapeutic frameworks for antimicrobial selection – largely based on systemic pharmacokinetic and pharmacodynamic principles – clinically irrelevant.

The paper emphasizes the pathogenetic rationale for the choice of dosage forms. The authors describes in detail the treatment strategy depending on the healing stage: using powder formulations during the inflammatory phase to ensure powerful exudate absorption and wound decontamination, and switching to ointment formulations during the regeneration phase to protect granulation tissue and prevent secondary infection. The clinical effectiveness of this strategy is confirmed by presented cases of successful treatment of complicated forms of pyoderma, folliculitis, and streptoderma, including in patients with severe comorbidities (diabetes mellitus, heart failure). The conclusion is that appropriate topical therapy not only optimize healing prosess but also reduces the burden on systemic circulation, limiting the growth of global antibiotic resistance.

1. Mitish VA, Paskhalova YuS, Tsvetkov VO, et al. Skin and soft tissue infections. Draft of clinical guidelines. Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2025;12(1):6-57. (In Russ.) doi: https://doi.org/10.25199/2408-9613-2025-12-1-6-57

2. Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: A review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Can J Infect Dis Med Microbiol. 2008;19(2):173-184. doi: https://doi.org/10.1155/2008/846453

3. Vella V, Derreumaux D, Aris E, et al. The Incidence of Skin and Soft Tissue Infections in the United States and Associated Healthcare Utilization Between 2010 and 2020. Open Forum Infect Dis. 2024;11(6):ofae267. doi: https://doi.org/10.1093/ofid/ofae267

4. Cunto ER, Colque AM, Herrera MP, et al. Severe skin and soft tissue infections. An update. Medicina (B Aires). 2020;80(5):531-540.

5. Ray GT, Suaya JA, Baxter R. Incidence, microbiology, and patient characteristics of skin and soft-tissue infections in a U.S. population: a retrospective population-based study. BMC Infect Dis. 2013;13:252. doi: https://doi.org/10.1186/1471-2334-13-252

6. Habib A, Qadir A. Frequency and Antibiotic Susceptibility Pattern of Community-associated Methicillin-resistant <em>Staphylococcus Aureus</em> (CAMRSA) in Uncomplicated Skin and Soft Tissue Infections. J Coll Physicians Surg Pak.2022;32(11):1398-1403. doi: https://doi.org/10.29271/jcpsp.2022.11.1398

7. Kaye KS, Petty LA, Shorr AF, Zilberberg MD. Current Epidemiology, Etiology, and Burden of Acute Skin Infections in the United States. Clin Infect Dis. 2019;68 (Suppl 3):S193S199. doi: https://doi.org/10.1093/cid/ciz002

8. Rodin AV, Danilenkov VV, Privolnev VV. Topical use of antibiotics in the treatment of wound infections as exemplified by the effects of neomycin. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2018;3-4:42-50. (In Russ.). doi: https://doi.org/10.21518/1995-1477-2018-3-4-42-50

9. Zilberberg MD, Shorr AF, Micek ST, et al. Epidemiology and outcomes of hospitalizations with complicated skin and skin-structure infections: implications of healthcare-associated infection risk factors. Infect Control Hosp Epidemiol. 2009;30(12):1203-1210. doi: https://doi.org/10.1086/648083

10. Silverberg B. A Structured Approach to Skin and Soft Tissue Infections (SSTIs) in an Ambulatory Setting. Clin Pract. 2021;11(1):65-74. doi: https://doi.org/10.3390/clinpract11010011

11. Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clin Proc. 2011;86(2):156-167. doi: https://doi.org/10.4065/mcp.2010.0639

12. Ray P, Singh S, Gupta S. Topical antimicrobial therapy: Current status and challenges. Indian J Med Microbiol. 2019;37(3):299-308. doi: https://doi.org/10.4103/ijmm.IJMM_19_443

13. EUCAST. MIC distributions for Neomycin. 2026. URL: https://mic.eucast.org/search/ (дата доступа: 01.04.2026)

14. Belkova YuА, Kozlov RS, Krechikova OI, et al. Comparative Efficacy of Topical Combination of Bacitracin and Neomycin vs. Chloramphenicol in the Treatment of Uncomplicated Mild to Moderate Surgical Skin and Soft Tissue Infections in Adult Out-patients Clinical Microbiology and Antimicrobial Chemotherapy. 2023(2):131-142. (In Russ.)

15. General characteristics of the medicinal product Baneocin®, powder for external use 250 IU/g + 5000 IU/g (LP-No.(011600)-(RG-RU) (In Russ.) URL: https://eec.eaeunion.org/ (дата доступа: 01.04.2026)

16. General characteristics of the medicinal product Baneocin®, ointment for external use 250 IU/g + 5000 IU/g (LP-No.(010189)-(RG-RU). (In Russ.)URL: https://eec.eaeunion.org/ (дата доступа: 01.04.2026)