MANAGEMENT OF SKIN AND SOFT TISSUE INFECTIONS IN BULGARIAN ARMY.

INTRODUCTION: The frequency of skin and soft tissue infections (SSTIs) has increased over the last decade due to increased predispositions to those illnesses - diabetes, malignant diseases, obesity, varices, dermatomycosis, etc. MATERIALS and METHOD‟s: In this retrospective study we analyzed 368 military personnel with SSTIs, hospitalized in Clinic of infectious diseases of Military Medical Academy, Sofia for the period January 2006 - December 2012. The study population was grouped according to: gender, age, location of the exanthema, underlying comorbidities, immunodeficiency, risk factors, complications and recurrences. RESULT‟s and DISCUSSION: Of the 368 patients, 317 (86.1%) were male and 51 (13.9%) female, with mean age 32±6. The most common skin and soft tissue infections were erysipelas 198 (53.8%) followed by impetigo 82 (22.3%), cellulitis 44 (11.9%), post-operative wound infections 39 (10.6%) and necrotizing fasciitis 5 (1.4%). Most frequently was affected shank (63.3%), thigh (10.1%), face (10.6%), arm (8.5%), abdomen (4.8%) and chest (2.7%). Diagnosis was based on epidemiological, clinical, hystopatological and microbiological data. Among the isolates tested 185 (50.3%) were beta-hemolytic Streptococcus group A, followed by Staphylococcus aureus - 102 (27.7%); Streptococcus viridians 42 (11.4%); E. faecalis - 14 (3.9%); Haemophilus influenzae 11 (2.9%); P. vulgaris - 7 (1.9%); Ps. aeruginosa - 5 (1.4%) and B. cereus - 2 (0.5%). The approach of treatment has been guided by the microbiological type of SSTIs and the severity of clinical presentation. Given the increasing number of methicillinresistant Staphylococcus aureus, beta-lactam antibiotics are no longer reliable empiric therapy for SSTIs. As an alternative etiological therapy we used Vancomycin, Clindamycin, Rifampin, Meropenem, Linezolid, Daptomycin, Tigecyclime, Telavancin and Quinupristindalfopristin. Surgical treatment included incision, drainage and debridement applied in 24 (6.5%) patients. CONCLUSION‟s: The main problem was patients with SSTIs in age group 30-40, with obesity, metabolic disorders, heart diseases and frequent traumatism. There was statistically significant difference in clinical improvement between patients treated with beta-lactam antibiotics and those treated with Daptomycin, Tigecyclin and Telavancin. They can be alternative in parenteral treatment of patients with multiple predisposing SSTIs factors, complications, multiple recurrences and isolated Grampositive cocci. [ABSTRACT FROM AUTHOR]