Recurrence of skin and soft tissue infections: identifying risk factors and treatment strategies.

PURPOSE OF REVIEW: Recurrent skin and soft tissue infections (RSSTIs) are challenging for the clinicians due to morbidity and healthcare-related costs. Here, we review updates on risk factors and management.

RECENT FINDINGS: RSSTIs rates range between 7 and 45%. Local and systemic conditions can favour RSSTIs, with comorbidities such as obesity, diabetes, cancer and immunosuppressive disease becoming increasingly relevant. Streptococcus spp . and Staphylococcus aures (including methicillin resistant, MRSA) are the leading causative pathogens of RSSTIs, but also Gram-negative bacteria and polymicrobial infection should be considered. To prevent recurrences, treatment of underlying predisposing factor, complete source control and appropriate antibiotic therapy are crucial. Antibiotic prophylaxis for recurrent erysipelas and decolonization for MRSA carriers demonstrated some advantages, but also long-term loss of efficacy and possible adverse effects. Clinical score and patients risk stratification could be useful tools to target prophylaxis and decolonization strategies. To reduce hospitalization rates and costs, outpatient oral and parenteral antibiotic therapy (OPAT) and long-acting antibiotics are being implemented.

SUMMARY: Management of RSSTIs requires both preventive interventions on modifiable risk factors and pharmacological strategies, with a patient tailored approach.