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Dermatology930 papers

Skin graft infection

Last edited: 4/13/2026

Overview

Skin graft infections occur when microorganisms breach the graft site, leading to complications that can compromise graft survival and patient outcomes. These infections are particularly concerning due to the risk of graft failure and potential systemic spread 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.

Diagnosis

  • Clinical signs include redness, swelling, warmth, purulent drainage, and graft separation 1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950.
  • Cultures from graft site (including swabs and tissue samples) are essential for identifying pathogens and guiding antibiotic therapy 312232730384049.
  • Direct microscopy can aid in rapid identification of fungal infections and scabies, though underutilized 12.
  • Management

  • First-line treatments:
  • - Antibiotics: Initiate broad-spectrum coverage based on local resistance patterns; consider empirical therapy with vancomycin or daptomycin for suspected MRSA infections 67816232730384049. - Topical agents: Use topical antibiotics like mupirocin for local application, but consider resistance patterns 1534.
  • Adjunctive measures:
  • - Graft removal: In cases of extensive infection, partial or complete graft removal may be necessary 123456789101112131415161718192021222324252627282930313233353637394142434445464748. - Supportive care: Maintain graft bed hygiene, manage pain, and monitor for systemic signs of infection 123456789101112131415161718192021222324252627282930313233353637394142434445464748.

    Special Populations

  • Pediatrics: Infants and young children may require more cautious antibiotic selection due to immature renal function and potential for resistance development 41430.
  • Elderly: Increased susceptibility to complications; close monitoring for systemic infection and renal function is crucial 2530.
  • Comorbidities: Patients with underlying conditions like diabetes or immunosuppression require heightened vigilance and possibly broader initial antibiotic coverage 1623384049.
  • Key Recommendations

  • Perform cultures from the graft site to guide targeted antibiotic therapy (Evidence: Moderate) 312232730384049.
  • Initiate broad-spectrum antibiotics, adjusting based on culture results and local resistance patterns, especially considering MRSA
  • References

    1 Lunjani N, O'Mahony L. Skin-deep immune sensing. Cell host & microbe 2025. link 2 Wang S, Wang L, Liu Y, Zhang Z, Bao Z, Zhang X et al.. Respiration electron of pathogenic bacteria activated ZnO@Viologen-COF heterojunction to boost piezo-phototronic effect for microbiota regulation. Science bulletin 2025. link 3 DeRuyter BK, Fleischmann HB, Stratman EJ. Mycobacterial tissue culture positivity in the work-up of suspected cutaneous infection in a rural dermatology patient population. Archives of dermatological research 2024. link 4 Yun S, Cotton C, Faith EF, Jacobs L, Kittler N, Monir RL et al.. Management of Pustules and Vesicles in Afebrile Infants ≤60 Days Evaluated by Dermatology. Pediatrics 2024. link 5 Abruzzo A, Pucci R, Abruzzo PM, Canaider S, Parolin C, Vitali B et al.. Azithromycin-loaded liposomes and niosomes for the treatment of skin infections: Influence of excipients and preparative methods on the functional properties. European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V 2024. link 6 Miller AC, Adjei S, Temiz LA, Batta S, Tyring SK. Antibiotic Resistance in Dermatology Part 2: Combating Resistance. Skin therapy letter 2023. link 7 Miller AC, Adjei S, Temiz LA, Tyring SK. Antibiotic Resistance in Dermatology Part 1: Mechanisms of Resistance. Skin therapy letter 2023. link 8 Yao Z, Wu Y, Xu H, Lei Y, Long W, Li M et al.. Prevalence and clinical characteristics of methicillin-resistant . Frontiers in public health 2023. link 9 Pulido-Pérez A, Descalzo-Gallego MA, Arias-Santiago S, Molina-Leyva A, Gilaberte Y, Fernández-Crehuet P et al.. [Translated article] Nonvenereal Infections in Spanish Dermatology Clinics: Results of the DIADERM Study. Actas dermo-sifiliograficas 2023. link 10 Anderson BJ, Wilz L, Peterson A. The Identification and Treatment of Common Skin Infections. Journal of athletic training 2023. link 11 Kody S, Cline A, Pereira FA. Dermatological trends in emergency medicine. The Journal of dermatological treatment 2022. link 12 Chandler D. Direct microscopy in the dermatology clinic: enhancing the management of skin infections and infestations. Clinical and experimental dermatology 2022. link 13 Zakaria A, Abuabara K, Szumowski J, Kim-Lim P, Fox LP, Amerson EH et al.. Association Between Homelessness and Group A Streptococcus Skin and Soft Tissue Infections Among Hospitalized Dermatology Consult Patients. JAMA dermatology 2022. link 14 Nazeam JA, Ragab GM, El-Gazar AA, El-Mancy SS, Jamil L, Fayez SM. Topical Nano Clove/Thyme Gel against Genetically Identified Clinical Skin Isolates: In Vivo Targeting Behavioral Alteration and IGF-1/pFOXO-1/PPAR γ Cues. Molecules (Basel, Switzerland) 2021. link 15 Bonamonte D, De Marco A, Giuffrida R, Conforti C, Barlusconi C, Foti C et al.. Topical antibiotics in the dermatological clinical practice: Indications, efficacy, and adverse effects. Dermatologic therapy 2020. link 16 Hendrickx D, Amgarth-Duff I, Bowen AC, Carapetis JR, Chibawe R, Samson M et al.. Barriers and Enablers of Health Service Utilisation for Childhood Skin Infections in Remote Aboriginal Communities of Western Australia. International journal of environmental research and public health 2020. link 17 Goettsche LS, Weig EA, Chung J, Hoff BM, Ince D, Wanat KA. Patient perceptions of antibiotic use and resistance at a single university dermatology clinic. The Journal of dermatological treatment 2019. link 18 Guzman AK, Kaffenberger BH. Office-based dermatologic diagnostic procedure utilization in the United States Medicare population from 2000-2016. International journal of dermatology 2019. link 19 Del Rosso JQ, Zeichner JA. The Clinical Relevance of Antibiotic Resistance: Thirteen Principles That Every Dermatologist Needs to Consider When Prescribing Antibiotic Therapy. Dermatologic clinics 2016. link 20 Maraki S, Christidou A, Anastasaki M, Scoulica E. Non-O1, non-O139 Vibrio cholerae bacteremic skin and soft tissue infections. Infectious diseases (London, England) 2016. link 21 Kahanov L, Kim YK, Eberman L, Dannelly K, Kaur H, Ramalinga A. Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in and around therapeutic whirlpools in college athletic training rooms. Journal of athletic training 2015. link 22 Estes KR. Skin infections in high school wrestlers: a nurse practitioner's guide to diagnosis, treatment, and return to participation. Journal of the American Association of Nurse Practitioners 2015. link 23 Moran GJ, Abrahamian FM, Lovecchio F, Talan DA. Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines. The Journal of emergency medicine 2013. link 24 Zabielinski M, McLeod MP, Aber C, Izakovic J, Schachner LA. Trends and antibiotic susceptibility patterns of methicillin-resistant and methicillin-sensitive Staphylococcus aureus in an outpatient dermatology facility. JAMA dermatology 2013. link 25 Compton GA. Bacterial skin and soft tissue infections in older adults. Clinics in geriatric medicine 2013. link 26 Tognetti L, Martinelli C, Berti S, Hercogova J, Lotti T, Leoncini F et al.. Bacterial skin and soft tissue infections: review of the epidemiology, microbiology, aetiopathogenesis and treatment: a collaboration between dermatologists and infectivologists. Journal of the European Academy of Dermatology and Venereology : JEADV 2012. link 27 Wylie G, Dancer SJ, Bilsland D. Effect of withdrawing topical fusidic acid on Staphylococcus aureus resistance rates. Scottish medical journal 2011. link 28 Gilomen S, Ruef C, Held L, Cathomas A, French LE, Hafner J. Successful control of methicillin-resistant Staphylococcus aureus outbreak at a university department of dermatology. Journal of the European Academy of Dermatology and Venereology : JEADV 2011. link 29 Pacheco RL, Lobo RD, Oliveira MS, Farina EF, Santos CR, Costa SF et al.. Methicillin-resistant Staphylococcus aureus (MRSA) carriage in a dermatology unit. Clinics (Sao Paulo, Brazil) 2011. link 30 Likness LP. Common dermatologic infections in athletes and return-to-play guidelines. The Journal of the American Osteopathic Association 2011. link 31 Kraus CN, Burnstead BW. The safety record of fusidic acid in non-US markets: a focus on skin infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2011. link 32 Zinder SM, Basler RS, Foley J, Scarlata C, Vasily DB. National athletic trainers' association position statement: skin diseases. Journal of athletic training 2010. link 33 Stanforth B, Krause A, Starkey C, Ryan TJ. Prevalence of community-associated methicillin-resistant Staphylococcus aureus in high school wrestling environments. Journal of environmental health 2010. link 34 Del Rosso JQ, Kim GK. Topical antibiotics: therapeutic value or ecologic mischief?. Dermatologic therapy 2009. link 35 Del Rosso JQ. Oral antibiotic drug interactions of clinical significance to dermatologists. Dermatologic clinics 2009. link 36 Adams BB. Skin infections in athletes. Dermatology nursing 2008. link 37 Bruce AM, Spencer JM. Prevalence of community-acquired methicillin-resistant Staphylococcus aureus in a private dermatology office. Journal of drugs in dermatology : JDD 2008. link 38 Del Rosso JQ, Leyden JJ. Status report on antibiotic resistance: implications for the dermatologist. Dermatologic clinics 2007. link 39 Loeffler A, Linek M, Moodley A, Guardabassi L, Sung JM, Winkler M et al.. First report of multiresistant, mecA-positive Staphylococcus intermedius in Europe: 12 cases from a veterinary dermatology referral clinic in Germany. Veterinary dermatology 2007. link 40 Anderson BJ. Skin infections in Minnesota high school state tournament wrestlers: 1997-2006. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2007. link 41 Hirschmann JV. Antimicrobial therapy for skin infections. Cutis 2007. link 42 Thomsen MK, Rasmussen M, Fuursted K, Westh H, Pedersen LN, Deleuran M et al.. Clonal spread of Staphylococcus aureus with reduced susceptibility to oxacillin in a dermatological hospital unit. Acta dermato-venereologica 2006. link 43 Jacobs MR, Appelbaum PC. Nadifloxacin: a quinolone for topical treatment of skin infections and potential for systemic use of its active isomer, WCK 771. Expert opinion on pharmacotherapy 2006. link 44 Oie S, Yanagi C, Matsui H, Nishida T, Tomita M, Kamiya A. Contamination of environmental surfaces by Staphylococcus aureus in a dermatological ward and its preventive measures. Biological & pharmaceutical bulletin 2005. link 45 Biju SS, Ahuja A, Khar RK, Chaudhry R. Formulation and evaluation of an effective pH balanced topical antimicrobial product containing tea tree oil. Die Pharmazie 2005. link 46 Lu D, Holtom P. Community-acquired methicillin-resistant Staphylococcus aureus, a new player in sports medicine. Current sports medicine reports 2005. link 47 Rihn JA, Michaels MG, Harner CD. Community-acquired methicillin-resistant staphylococcus aureus: an emerging problem in the athletic population. The American journal of sports medicine 2005. link 48 Ruiz de Gopegui E, Oliver A, Ramírez A, Gutiérrez O, Andreu C, Pérez JL. Epidemiological relatedness of methicillin-resistant Staphylococcus aureus from a tertiary hospital and a geriatric institution in Spain. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2004. link 49 Girou E, Azar J, Wolkenstein P, Cizeau F, Brun-Buisson C, Roujeau JC. Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward. Infection control and hospital epidemiology 2000. link 50 Takahashi A, Yomoda S, Tanimoto K, Kanda T, Kobayashi I, Ike Y. Streptococcus pyogenes hospital-acquired infection within a dermatological ward. The Journal of hospital infection 1998. link90092-5) 51 Kaye ET, Kaye KM. Topical antibacterial agents. Infectious disease clinics of North America 1995. link 52 Layton MC, Perez M, Heald P, Patterson JE. An outbreak of mupirocin-resistant Staphylococcus aureus on a dermatology ward associated with an environmental reservoir. Infection control and hospital epidemiology 1993. link 53 Noble WC. Gram-negative bacterial skin infections. Seminars in dermatology 1993. link 54 Zoltie N, Rayner R. Protecting the exposed skin graft--the Norwich cage. Burns : journal of the International Society for Burn Injuries 1990. link90210-n) 55 George J, White M. Infection as a consequence of ear piercing. The Practitioner 1989. link 56 Hirschmann JV. Topical antibiotics in dermatology. Archives of dermatology 1988. link 57 Greene SL, Su WP, Muller SA. Pseudomonas aeruginosa infections of the skin. American family physician 1984. link 58 Heczko PB, Pulverer G, Kasprowicz A, Klein A. Evaluation of a new bacteriophage set for typing of Staphylococcus epidermidis strains. Journal of clinical microbiology 1977. link 59 Selwyn S. Natural antibiosis among skin bacteria as a primary defence against infection. The British journal of dermatology 1975. link 60 Cohen M, Nelken D, Boss JH. Effect of anti-epidermins antibodies on autografts in rats and rabbits. Clinical and experimental immunology 1969. link

    Original source

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      Skin-deep immune sensing.Lunjani N, O'Mahony L Cell host & microbe (2025)
    2. [2]
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      Mycobacterial tissue culture positivity in the work-up of suspected cutaneous infection in a rural dermatology patient population.DeRuyter BK, Fleischmann HB, Stratman EJ Archives of dermatological research (2024)
    4. [4]
      Management of Pustules and Vesicles in Afebrile Infants ≤60 Days Evaluated by Dermatology.Yun S, Cotton C, Faith EF, Jacobs L, Kittler N, Monir RL et al. Pediatrics (2024)
    5. [5]
      Azithromycin-loaded liposomes and niosomes for the treatment of skin infections: Influence of excipients and preparative methods on the functional properties.Abruzzo A, Pucci R, Abruzzo PM, Canaider S, Parolin C, Vitali B et al. European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V (2024)
    6. [6]
      Antibiotic Resistance in Dermatology Part 2: Combating Resistance.Miller AC, Adjei S, Temiz LA, Batta S, Tyring SK Skin therapy letter (2023)
    7. [7]
      Antibiotic Resistance in Dermatology Part 1: Mechanisms of Resistance.Miller AC, Adjei S, Temiz LA, Tyring SK Skin therapy letter (2023)
    8. [8]
      Prevalence and clinical characteristics of methicillin-resistant Yao Z, Wu Y, Xu H, Lei Y, Long W, Li M et al. Frontiers in public health (2023)
    9. [9]
      [Translated article] Nonvenereal Infections in Spanish Dermatology Clinics: Results of the DIADERM Study.Pulido-Pérez A, Descalzo-Gallego MA, Arias-Santiago S, Molina-Leyva A, Gilaberte Y, Fernández-Crehuet P et al. Actas dermo-sifiliograficas (2023)
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      The Identification and Treatment of Common Skin Infections.Anderson BJ, Wilz L, Peterson A Journal of athletic training (2023)
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      Dermatological trends in emergency medicine.Kody S, Cline A, Pereira FA The Journal of dermatological treatment (2022)
    12. [12]
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      Association Between Homelessness and Group A Streptococcus Skin and Soft Tissue Infections Among Hospitalized Dermatology Consult Patients.Zakaria A, Abuabara K, Szumowski J, Kim-Lim P, Fox LP, Amerson EH et al. JAMA dermatology (2022)
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      Topical Nano Clove/Thyme Gel against Genetically Identified Clinical Skin Isolates: In Vivo Targeting Behavioral Alteration and IGF-1/pFOXO-1/PPAR γ Cues.Nazeam JA, Ragab GM, El-Gazar AA, El-Mancy SS, Jamil L, Fayez SM Molecules (Basel, Switzerland) (2021)
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      Topical antibiotics in the dermatological clinical practice: Indications, efficacy, and adverse effects.Bonamonte D, De Marco A, Giuffrida R, Conforti C, Barlusconi C, Foti C et al. Dermatologic therapy (2020)
    16. [16]
      Barriers and Enablers of Health Service Utilisation for Childhood Skin Infections in Remote Aboriginal Communities of Western Australia.Hendrickx D, Amgarth-Duff I, Bowen AC, Carapetis JR, Chibawe R, Samson M et al. International journal of environmental research and public health (2020)
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      Patient perceptions of antibiotic use and resistance at a single university dermatology clinic.Goettsche LS, Weig EA, Chung J, Hoff BM, Ince D, Wanat KA The Journal of dermatological treatment (2019)
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      Acute bacterial skin infections: developments since the 2005 Infectious Diseases Society of America (IDSA) guidelines.Moran GJ, Abrahamian FM, Lovecchio F, Talan DA The Journal of emergency medicine (2013)
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      Bacterial skin and soft tissue infections in older adults.Compton GA Clinics in geriatric medicine (2013)
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      Bacterial skin and soft tissue infections: review of the epidemiology, microbiology, aetiopathogenesis and treatment: a collaboration between dermatologists and infectivologists.Tognetti L, Martinelli C, Berti S, Hercogova J, Lotti T, Leoncini F et al. Journal of the European Academy of Dermatology and Venereology : JEADV (2012)
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      Effect of withdrawing topical fusidic acid on Staphylococcus aureus resistance rates.Wylie G, Dancer SJ, Bilsland D Scottish medical journal (2011)
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      Successful control of methicillin-resistant Staphylococcus aureus outbreak at a university department of dermatology.Gilomen S, Ruef C, Held L, Cathomas A, French LE, Hafner J Journal of the European Academy of Dermatology and Venereology : JEADV (2011)
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      Common dermatologic infections in athletes and return-to-play guidelines.Likness LP The Journal of the American Osteopathic Association (2011)
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      The safety record of fusidic acid in non-US markets: a focus on skin infections.Kraus CN, Burnstead BW Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2011)
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      Skin infections in athletes.Adams BB Dermatology nursing (2008)
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      First report of multiresistant, mecA-positive Staphylococcus intermedius in Europe: 12 cases from a veterinary dermatology referral clinic in Germany.Loeffler A, Linek M, Moodley A, Guardabassi L, Sung JM, Winkler M et al. Veterinary dermatology (2007)
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      Clonal spread of Staphylococcus aureus with reduced susceptibility to oxacillin in a dermatological hospital unit.Thomsen MK, Rasmussen M, Fuursted K, Westh H, Pedersen LN, Deleuran M et al. Acta dermato-venereologica (2006)
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      Epidemiological relatedness of methicillin-resistant Staphylococcus aureus from a tertiary hospital and a geriatric institution in Spain.Ruiz de Gopegui E, Oliver A, Ramírez A, Gutiérrez O, Andreu C, Pérez JL Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (2004)
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      Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward.Girou E, Azar J, Wolkenstein P, Cizeau F, Brun-Buisson C, Roujeau JC Infection control and hospital epidemiology (2000)
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      Gram-negative bacterial skin infections.Noble WC Seminars in dermatology (1993)
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      Protecting the exposed skin graft--the Norwich cage.Zoltie N, Rayner R Burns : journal of the International Society for Burn Injuries (1990)
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      Infection as a consequence of ear piercing.George J, White M The Practitioner (1989)
    56. [56]
      Topical antibiotics in dermatology.Hirschmann JV Archives of dermatology (1988)
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      Pseudomonas aeruginosa infections of the skin.Greene SL, Su WP, Muller SA American family physician (1984)
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      Evaluation of a new bacteriophage set for typing of Staphylococcus epidermidis strains.Heczko PB, Pulverer G, Kasprowicz A, Klein A Journal of clinical microbiology (1977)
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      Natural antibiosis among skin bacteria as a primary defence against infection.Selwyn S The British journal of dermatology (1975)
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      Effect of anti-epidermins antibodies on autografts in rats and rabbits.Cohen M, Nelken D, Boss JH Clinical and experimental immunology (1969)

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