I read with great interest the article by Paydar et al1 showing that treatment of soft tissue infections caused by Staphylococcus aureus after surgical drainage, even with inappropriate antibiotics, has a high cure rate. In their study, an important finding is that in a subgroup from the cohort of 272 patients with available demographic data, 58% were injection drug users. This can influence the results of the study. Cutaneous infections are the most common infections in injection drug users.2- 9 A wide range of pathogens, including almost all bacteria and fungi, have been isolated in these infections, but the most common are S aureus, group A beta hemolytic Streptococcus, other Streptococci, and anaerobes.2- 9 Recurrent skin infections in this population are frequent and could result in the chronic stimulation of the immune system, which can help cure the skin infection.
Del Giudice P. Inappropriate Antibiotic Use in Soft Tissue Infections in Injection Drug Users. Arch Surg. 2007;142(6):575–576. doi:10.1001/archsurg.142.6.575-b