SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo BassettiThe role of multidrug and extensive-drug resistant Gam-negative bacteria in skin and soft tissue infectionsBrink, Adrian J.a; Richards, Guy A.bAuthor Information aDivision of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town bDepartment of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Correspondence to Adrian J. Brink, Professor and Head, Division of Medical Microbiology, 5th floor, Suite 5.28, Falmouth Building, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa. Tel: +21 406 6083; e-mail: firstname.lastname@example.org Current Opinion in Infectious Diseases: April 2020 - Volume 33 - Issue 2 - p 93-100 doi: 10.1097/QCO.0000000000000636 Buy Metrics Abstract Purpose of review Whereas Staphylococcus aureus remains the leading cause of skin and soft tissue infections (SSTI), Gram-negative bacilli (GNB) are increasingly reported as a cause of monomicrobial or polymicrobial infections. This review examines the expanding role of GNB in SSTI and discusses the risks for and the frequency of multidrug-resistance (MDR) and extensive drug-resistance (XDR) and the implications with regard to outcome and therapy. Recent findings Although the global epidemiology and role of GNB in SSTIs have not been studied systematically, complicated SSTIs caused by resistant GNB are increasing particularly in vulnerable patients with long-standing infections, those in long-term care facilities, and those with a history of recent hospitalization or prior antibiotic therapy. Mixed infections also occur in up to 25% of SSTIs, and inappropriate therapy occurs in 40% of cases. Prompt identification of the causative pathogen requires that patients with SSTI be risk stratified according to the likelihood of resistance to enable early recognition and swift initiation of appropriate therapy. Summary For individual treatment decisions in SSTIs, institutional diagnostic and treatment algorithms based on local epidemiology and risk factors are pivotal to reducing the incidence of treatment failure and improving outcomes associated with resistant GNB. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.