Managing Pyogenic Soft-Tissue Infections in People Living With HIV in a Resource-Limited Setting: Field Lessons and a Pragmatic Algorithm From South Sudan

Abstract

Severe pyogenic soft-tissue infections (SSTI) are a frequent cause of morbidity among people living with HIV (PLHIV) in resource-limited hospitals. Drawing on five months of frontline work in a district surgical unit in South Sudan, this field report distills practical lessons into a simple, resource-adapted algorithm for triage, source control, antibiotics, and wound care. Core steps include bedside sepsis screening with qSOFA, prompt empiric antibiotics aligned with the WHO EML/AWaRe approach, and decisive operative debridement without waiting for advanced diagnostics when necrotizing infection is suspected, followed by planned re-look procedures. Low-cost wound-care options (eg, diluted hypochlorite/povidone-iodine transitioning to saline gauze) and loss-to-follow-up–aware discharge practices are emphasized. The aim is to standardize care and shorten time to debridement in district-level services rather than report outcomes. Keywords: pyogenic soft-tissue infection; HIV; resource-limited settings; necrotizing fasciitis.