Skin and Soft Tissue Infections in Pregnancy

Abstract

Skin and soft tissue infections (SSTIs) are an important cause of morbidity and mortality in pregnant and postpartum women. SSTIs in pregnancy and puerperium range from mild to a moderate variety of infections like cellulitis, simple abscess, mastitis to severe degrees of fulminant infections like necrotizing fasciitis. Most SSTIs in puerperium originate at the breast, infected wound site following a surgical procedure, or traumatic vaginal deliveries. Mastitis and breast abscess represent an important category of SSTIs in the postpartum period associated with high morbidity; also affecting the neonatal well-being resulting from discontinuation of breastfeeding. SSTIs like necrotizing fasciitis are a rare but potential source of life-threatening complications in pregnant and postpartum women with high maternal mortality. Dominant organisms that are isolated in most cases of SSTIs are Gram-positive bacteria such as Staphylococcus aureus and Streptococcus; however, polymicrobial infections with Gram-negative and anaerobic organisms are not uncommon in severe infections. Uncomplicated SSTIs are successfully managed on an outpatient basis; severe infections extending to the deeper tissues—subcutaneous tissue, fascia, or muscle require aggressive management. Early diagnosis, the institution of appropriate antibiotics, and well-timed surgical management, if required, are key to the effective management of complicated SSTI to prevent maternal morbidity and mortality. Here, we review the etiopathology, clinical features, and treatment strategies for the management of SSTIs in pregnancy and the postpartum period.