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PHRM 865: Theraputics V > Lecture 16: Skin/Soft Tissue Infections > Flashcards

Lecture 16: Skin/Soft Tissue Infections Flashcards

1
Q

What are the most common Skin/Soft Tissue Infections?

A
  • Impetigo
  • Erysipelas
  • Cellulitis
  • Necrotizing Faciitis
  • Diabetic Foot Infections

MOST COMMONLY caused by b-hemolytic strep & Staph aureus

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2
Q

What are some of the mechanisms of defense for S/STi?

A
  • Skin [physical barrier]
  • Low pH [~5.6]
  • Dry environments

Alteration to any of these will cause a skin infection

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3
Q

What are the common skin flora?

A
  • Corynebacterium Diphtheriae
  • Staph Epidermidis
  • Streptococci [Group]
  • Cutibacterium
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4
Q

What are some of the important risk factors asscoiated with S/STi?

A
  • Immune Status
  • Geographic Location
  • Lifestyle
  • Traveling
  • Reacent trauma or surgery
  • PHM
  • etc
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5
Q

Which of the following can predispose a patient for a S/STi?

A] Decreased skin perfusion
B] Availability of bacterial nurtients
C] Damage to the skin
D] All of the above

A
  • D] All of the above
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6
Q

What is the Impetigo?

A
  • Purulent Superficial Infection involving the epidermis that have mulitple pustules rupture on the FACE & EXTREMITIES

HONEY colored look

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7
Q

What are some of the symptoms of Impetigo?

A
  • Maculopapular lesions that rupture leaving icthy or painful honey colored crust
  • VERY INFECTIOUS
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8
Q

What is the pathogensis of Impetigo?

A
  • Organisms directly invade skin [primary] OR superficially [epidermis] during a trauma [secondary]
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9
Q

What are some of the risk factors for Impetigo?

A
  • Chlidren [Day Care Settings]
  • Skin Trauma
  • Hot/Humid Climates
  • Poor Hyigene
  • Crowding
  • Malutrition
  • DM

Can basically spread very easily

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10
Q

What are some of the common bacteria that cause Impetigo?

A
  • Staph Aureus
  • Sterp Pyogenes
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11
Q

What is the treatment for Impetigo?

A
  • Cephelaxin: Adults - 250-500mg PO QID & Kid 25-50mg/kg/d PO in 3-4 divided doses
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12
Q

True or False: Impetigo most commonly occurs in adults and is not contagious?

A
  • FALSE
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13
Q

What is Cellulitis?

A
  • Acute spreading infection involving the skin
  • Mostly in the lower extremities
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14
Q

What are some of the symptoms of Cellulitis?

A
  • Redness, Tenderness, Warmth, Sweeling with a poorly defined border
  • Possibly fever, malaise, lymphadoenopathy, lymphangitis…
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15
Q

What is the pathogensis of Cellulitis?

A
  • Organisms into the skin during trauma, wounds, Athletes Foot, cracked skin, injections, ulcers surgery…

Basically anything that alters the integrity of the skin

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16
Q

What are some of the risk factors for Cellulitis?

A
  • DM
  • IV drug usage
  • Obesity
  • Lymphedema
  • Immunocompromised
17
Q

What are some of the important characterisitcs of CA-MRSA?

A
  • Close Contact [immates, injections, contact sports, children, tattoos…]
  • SCCmec type IV
  • Panton-Valentine Leukocidin [PVL] - causes necrosis & abcess
  • Cellulitis AND Abscess
18
Q

What is the empiric treatment for Cellulitis in Mild/Moderate Patients

A

PO: Dicloxacillin OR Cephalexin
CA-MRSA: SMX/TMP OR Clindamycin OR Linezoild

same in kids

MRSA should be suspected in patients whose cellulitis is assoicated with trauma, MRSA elsewhere, nasal PCR, Injections, purulent or SIRS

19
Q

What is the empiric treatment for Cellulitis in Moderate/Severe Patients?

A
  • IV: Nafcillin OR Cefazolin
  • CA-MRSA: Vancomycin OR Linezolid

MRSA should be suspected in patients whose cellulitis is assoicated with trauma, MRSA elsewhere, nasal PCR, Injections, purulent or SIRS

20
Q

For Cellulitis, what does the empiric treatment depend on?

A
  • Purulent = BOTH Staph Aureus and Group Strep
  • Non-Purulent = Group Strep and MSSA
21
Q

What is the Directed Treatment for Cellulitis?

S. Pyogenes? MRSA? Gram (-)?

A
  • S.Pyogenes: Penicillin
  • MRSA: Vancomycin, SMX/TMP, Clindamycin, Doxycycline
  • Gram (-): 3rd Gen Cephalo

5-7 Day treatment

22
Q

What is Erysipelas?

A
  • Cellulitis Variant from b-hemolytic strep that has sharp demarcated boarders
  • PEAU D’ ORANGE on FACE
23
Q

Which of the following best describes cellulitis?
A] Also called Peua d’ orange
B] Most often involves the face
C] Has Poorly defined margins
D] Involves only the upper dermis

A
  • C] Has poorly defined margins
24
Q

What is Necrotizing Faciitis?

A
  • Rare skin infection that has progessive destrution of fascia, subq fat and mucsle
  • On lower extremities, abdomen, or genitals
25
Q

What are some of the symptoms of Necrotizing Fasciitis?

A
  • Intense pain, wooden-hard skin, gangrene and system toxicity
26
Q

What is the pathogensis of Necrotizing fasciitis?

A
  • Same as Cellulitis BUT has toxin producing orgainsm
27
Q

What are some of the bacteria that can causes Necrtoizing Fasciitis?

A
  • Extremities: S. Pyogenes [toxin producing] & S. Aureus [CA-MRSA]
28
Q

What is the empiric treatment for Encrotizing fasciitis?

A
  • Vanomycin [MRSA]
  • Pip/Tazo OR meropenem [GNR + Anaerobes]
  • Clindamycin [Toxin Production]

Could also do Pip/Tazo OR Meropenem + Linezoild [MRSA + Toxin Production]

29
Q

Which of the following should be started if there is a concern for a Necrotizing Skin Infection?

A] Clindamycin
B] Ceftriaxone
C] Vancomycin
D] Pip/Tazo

A
  • A] Clindamycin
  • C] Vancomycin
  • D] Pip/Tazo
30
Q

What are Diabetic Foot Infections?

A
  • Infected foot ulcers, abscesses, cellulitis of the foot
  • Infalmmatory process involving a foot wound

Want to look at the Ankle Brachial Index, Cultures Labs [WBC…]

31
Q

What are the symptoms of Diabetic Foot Infections?

A
  • At least 2 of the following:
  • Redness, Warmth, Swelling, Tenderness, Pain, Purulent Discharge

May also have; fever, tachycardia, leukocytosis…

32
Q

What is the Pathogenesis of Diabetis Foot Infections?

A
  • Cause by neuropathy, angiopathy with ischemia, dry skin, decreased wound healing….
  • Patient has ulcer -> dont know b/c neuropathy -> DFI
33
Q

What is the Mild Wound Classifiation for Diabetis Foot Infection?

A
  • S&S: Redness > 0.5 but < 2cm
  • Systemic?: NO
  • Bone?: NO
34
Q

What is the Moderate Wound Classification for Diabetic Foot Infections?

A
  • S&S: Redness > 2cm; deeper wound
  • Systemic?: NO
  • Bone?: NO
35
Q

What is the Severe Wound Classification of Diabetic Foot Infections?

A
  • S&S: Redness ANY size
  • Systemic?: SIRS [2 of 4]
  • Bone?: Potentially

SIRS: Temp > 38; HR > 90bpm; RR > 20; WBC > 12K or <4k

36
Q

What are some of the MDR organism Risk Factors for Diabetic Foot Infections?

A
  • MRSA: Hx of MRSA, MRSA > 30-50%, Hospitalization in last 30 days
  • Pseudo: Soaking Feet, Wetness
37
Q

What are some of the treatment options for Mild Diabetic Foot Infections?

NO Factors? B-lactam Allergy? Recent Antibios? MRSA?

A
  • NO Factors: Cephalexin, Dicloxacillin, Augmentin
  • B-lactam Allergy: Clindamycin, SMX/TMP, Doxycycline
  • Recent Antibios: Augmentin, SMX/TMP
  • MRSA: SMX/TMP, clindamycin, doxycycline, linezoild

NO Factors & B-lactam Allergy: Staph, Strep
Recent Antibios: GNR + GPCs
MRSA: MRSA

38
Q

What are some of the treatment options fro Moderate Diabetic Foot Infections/

NO Factors? Recent Antibios? Warm Ulcers? MRSA? Ischemic Necro?

A
  • No Factors: IV Unasyn, Cefazolin
  • Recent Antibios: Ceftriaxone
  • Warm Ulcers: IV Zosyn, Mero/Imip
  • MRSA: + IV Vancomycin, Daptomycin, Linezolid
  • Ischemic Necro: Zosyn, Carbas OR Ceftriaxone/Cefepime + Metro

NO Factors: b-hemo Strep and/or staph
Recent Antibios: Enterbacterales
Warm Ulcers: GNR, Pseudo
MRSA: MRSA
Ischemic Necro: GPC + GMR + Anaerobes

39
Q

What are some of the treatment options for Severe Diabetic Foot Infections?

SIRS?

A
  • SIRS: Vancomycin + [Zosyn, Mero, Ceftazidime/cefepime] + Metro

SIRS: B-hemo Strep and/or Staph [MSSA & MRSA], Enterbacterlaes, Pseudo

PHRM 865: Theraputics V (42 decks)

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