Skin and soft tissue infection(皮膚軟組織感染,SSTI)先看有沒有膿。Purulent abscess(化膿性膿瘍)常是 S. aureus,社區型 MRSA 要考慮;nonpurulent cellulitis/erysipelas(非化膿性蜂窩性組織炎/丹毒)常是 beta-hemolytic streptococci(β 溶血性鏈球菌),S. aureus 也可能參與。Necrotizing fasciitis(壞死性筋膜炎)要看速度、疼痛遠大於外觀、毒性表現與暴露:GAS 可單菌種,腹會陰或糖尿病常 mixed flora(混合菌叢),海水/肝病要想 Vibrio vulnificus,創傷氣腫要想 Clostridium。
咬傷題很適合考暴露。貓狗咬傷快速 cellulitis 是 Pasteurella multocida;人咬傷或 clenched-fist injury(握拳傷)要想 Eikenella corrodens 加厭氧菌。Hot tub folliculitis(熱水池毛囊炎)是 Pseudomonas。淡水外傷、海水外傷、魚缸接觸也各有特殊病原,但國考先抓最常見幾個。
| 表現/暴露 | 病原 | 題眼 |
| Impetigo | S. aureus、GAS | Honey-colored crust |
| Erysipelas/cellulitis | GAS、S. aureus | 邊界清楚/不清、紅腫熱痛 |
| Abscess | S. aureus、CA-MRSA | Purulence、需 drainage 概念 |
| Necrotizing fasciitis | GAS、mixed anaerobes/GNR、Vibrio、Clostridium | Pain out of proportion、壞死、crepitus、shock |
| Cat/dog bite | Pasteurella multocida、anaerobes | 快速 cellulitis |
| Human bite | Eikenella、anaerobes | Clenched-fist injury |
| Hot tub folliculitis | Pseudomonas aeruginosa | 溫水池、毛囊炎 |
| Diabetic foot | Mixed flora、S. aureus、streptococci、GNR、anaerobes | 慢性傷口、骨髓炎 |