Dr. Puligandla -- Soft Tissue Infections Flashcards Preview

Block G -- Infection > Dr. Puligandla -- Soft Tissue Infections > Flashcards

Flashcards in Dr. Puligandla -- Soft Tissue Infections Deck (67)
1

Common and primary goal of surgical team

Prevention of surgical site infections in the OR

2

Goal of anti-sepsis

Prevent the contamination of the open surgical wound by isolating the operative site from the surrounding non-sterile environment

3

7 uncomplicated soft tissue infections

  • Cellulitis
  • Erysipelas
  • Abscess
  • Folliculitis
  • Furunculosis
  • Impetigo
  • Ecthyma

4

9 complicated soft tissue infections

  • Traumatic wound infectoin
  • Bite-related wound infection
  • Postop wound infection
  • Secondary infectio nof a diseased skin (i.e. eczema)
  • Diabetic foot infection
  • Vanous stasis ulcer/ infected pressure sores
  • Perianal skin infection
  • Necrotizing infection
  • Myonecrosis

5

Layers of skin involved in cellulitis

  • Epidermis
  • Dermis

6

3 organisms responsible for cellulitis

  • S. pyogenes
  • S. aureus
  • H. influenzae

7

3 symptoms of cellulitis

  • Pain
  • Erythema
  • Swelling

8

2 treatments for cellulitis

  • Antibiotics
  • Incision and drainage (I+D)

9

Define erysipelas

Superficial infection of skin that spreads rapidly and involved dermal lymphatics

10

Cause of erysipelas

GAS

11

4 symptoms of erysipelas

  • Fever
  • Pain
  • "Aches"
  • Adenitis

12

Usual location of erysipelas

Legs > face

13

Erysipelas treatment

Penicillin G

14

Skin layers involved in skin abscess

  • Epidermis
  • Dermis
  • Occasionally deeper structures

15

Usual cause of skin abscess

S. aureus

16

Treatment for skin abscess

I+D; antibiotics reseved for those with an associated cellulitis

17

4 antibiotics for mild cellulitis

  • TMP/SMX DS (160/800 mg) 1 - 2 tablets bid plus cephalexin 500 mg qid
  • Clindamycin 300 mg qid
  • Minocycline 100 mg bid (first dose 200 mg)
  • Doxycycline 100 mg bid

18

Define felon

Hand infection wherein distal pulp space of finer is compartmentalized by fibrous septa and infection arises from direct innoculation wtih bacteria (puncture wound; less commonly hematogenous spread)

19

Clinical manifestation of felon

Intensely painful throbbing pulp space

20

Potential complciation of felon

Pressure can lead to necrosis with spread to tendons, ligaments and bone

21

Treatment for felon

  • I+D
  • Antibiotics against common strep and staph species

22

Define paronychia

Infection of skin over the mantle of the nail or of the lateral nail fold

23

Clinical manifestation and potential complication of paronychia

Swollen, tender, with progression to felon is untreated

24

Treatment for paronychia

  • I+D
  • +/- removal of the nail

25

Define tenosynovitis

Hund infection due to a penetrating injury to volar surface involving tendom sheath

26

4 Kanavel's signs

  • Finger held in mild flexion
  • Fusiform swelling
  • Tender along tendon sheath
  • Pain with passive extension

27

4 complications of tenosynovitis

  • Tendon necrosis
  • Tendon sheath disruption
  • Contracture
  • Proximal extension

28

Treatment for tenosynovitis

  • Antibiotics
  • Surgical debridement

29

Organisms that can lead to infection due to a human bite

Aerobic and anaerobic

30

Treatment for human bite

  • Antibiotics
  • Possible debridement
  • DO NOT close punture site due to high risk of infection

31

3 antibiotics for outpatient therapy for dog, cat and human bites

  • Amoxicillin/clavulanate 875/125 mg bid
  • Moxifloxacin 400 mg daily
  • Clindamycin 300 mg qid plus Ciprofloxacin 500 mg bid

32

2 antibiotics for dog, cat, and human bite inpatient parenteral therapy

  • Ampicillin/sulbactam 1.5 g - 3 g IV q 6 h
  • Moxifloxacin 400 mg IV qd

33

Define diabetic foot

Glove and stocking neuropathy with compromised vascular supply +/- microvascular disease

34

Progression of diabetic foot

Cellulitis to chronic osteomyelitis

35

Why is diabetic foot difficult to treat?

Poor microcirculation

36

Treatment for diabetic foot

  • Antibiotics, debridement +/- amputation
  • Revascularization

37

3 organisms responsible for diabetic foot infection

  • GAS
  • S. aureus
  • Pseudomonas (deep)

38

Inpatient parenteral antibiotics for moderate-to-severe cellulitis or abscess (2)

  • Clindamycin 600 mg - 900 mg IV q 8 h
    • Monotherapy only for moderate
  • Vancomycin 1 g IV q 12 h +/- cefazolin 1 g IV q 6 h
    • May replace cefazolin with nafcillin or oxacillin 1 g-2 g every 4 h
    • Addition of beta-lactam may provide enhanced activity against MSSA or strep (pref. if S. aureus)

39

2 outpatient antibiotic therapies for diabetic foot infection

  • Clindamycin 300 mg qid plus Ciprofloxacin 500 mg bid
  • Amoxicillin/clavulanate 875/125 mg bid +/- TMP/SMX DS (160/800 mg) 1 - 2 tablets bid

40

3 inpatient parenteral antibiotics for diabetic foot infection

  • Ceftriaxone 1 g IV q 24 h + metronidazole 500 mg IV q 6 - 8 h +/- Vancomycin 1 g IV q 12 h
  • Ertapenem 1 g IV q 24 h +/- vancomycin 1 g IV q 12 h
  • Tigecycline 50 mg IV q 12 h (first dose 100 mg IV)

41

4 necrotizing infections

  • Clostridial infections
  • Necrotizing fasciitis
  • Bacterial synergistic gangrene
  • Streptococcal gangrene

42

Bacteriology of NI's (5 organisms)

  • Rarely single organism (except GAS)
    • B-hemolytic strep
    • Anaerobic GPC
    • Aerobic GNR
    • Bacteroides
  • NOTE: Synergy between aerobic and anaerobic organisms for the necrosis of skin, soft tissue and fascia

43

How to diagnose NI's (6)

  • Often lack any diagnostic external signs of necrotizing infection (maybe cellulitis or small ulcer)
  • Gold standard = tissue biopsy (frozen section, gram stain)
  • Plain radiographs
  • CT scan
  • MRI
  • Surgical debridement

44

Most frequent spontaneous site of NI

Perineum

45

Most frequent site overall for NI

Limbs (due to wound, puncture, injury)

46

7 predisposing events that put one at risk for NI

  • Minor trauma
  • Insect bites
  • IVDU
  • Drug reactions
  • Perirectal abscesses
  • Major trauma
  • Surgical procedures

47

8 associated conditions to NI

  • DM
  • Cancer
  • Immune suppression
  • Renal insufficiency
  • Older age
  • Malnutrition
  • Obesity
  • Arteriosclerosis

48

Define bacterial synergistic gangrene

  • Rare form of gangrene affecting trunk and limbs (Meleney's ulcer).
  • Slow infection affecting skin and soft tissues but not fascia

49

3 organisms responsible for bacterial synergistic gangrene

  • Streptococci
  • S. aureus
  • GNR

50

Treatment for bacterial synergistic gangrene

  • Antibiotics
  • Radical debridement

51

Define necrotizing fasciitis

Aggressive necrotizing infection involving the skin, soft tissue and fascia but not the muscle

52

3 symptoms associated with necrotizing fasciitis

  • Hypotension
  • Fever
  • Decreased level of consciousness

53

3 supportive treatments for necrotizing fasciitis

  • Resuscitation
  • Antibiotics
  • IVIG

54

3 surgical treatments for necrotizing fasciitis

  • Fascial probing
  • Radical debridement
  • Reconstruction

55

6 extracellular products of GAS capable of tissue destruction

  • Erythrogenic toxins A, B, and C
  • Streptolysins O and S
  • Streptokinases A and B
  • Ribo and deoxyribonucleases
  • Hyaluronidases, proteinases
  • Exotoxin A "superantigens"

56

3 supportive therapies for GAS infection

  • Mechanical ventilation
  • Fluid resuscitation
  • Inotropic medication for hypotension

57

Antibiotic therapy for GAS infection

Penicillin

58

Surgical management of GAS infection

Wide surgical debridement to normal tissue --> amputation

59

Define clostridial cellulitis

Slow progressive infection of the soft tissues sparing the muscle

60

Clinical manifestation of clostridial cellulitis

  • Crepitus (gas) in subcutaneous tissues
  • Foul-smelling exudate

61

2 organisms responsible for clostridial cellulitis

  • C. perfringes
  • C. sporogenes

62

Treatment for clostridial cellulitis

  • Wide debridement
  • Broad spectrum antibiotics (penicillin-based)

63

Define clostridial myonecrosis

Rapidly progressive infection involving dermis, fascia and muscle but sparing epidermis (no inflammation)

64

Clinical manifestation of clostridial myonecrosis

  • "Mousy smell"
  • Bronzing of skin

65

Treatment for clostridial myonecrosis

  • Rapid debridement often requiring amputation
  • Penicillin G = mainstay of treatment

66

2 antimicrobial treatment regimens for necrotizing soft tissue infections

  • Vancomycin 1 g IV q 1 h + Clindamycin 900 mg IV q 8 h + Pip/tazo 3.375 g IV q 6 h
    • Can replace vancomysin with daptomycin
    • Can replace pip/tazo with imipenem or meropenem
  • Linezolid 600 mg IV q 12 h + pip/tazo 3.375 g IV q 6 h

67

9 uses for hyperbaric oxygen treatment

  • Chronic non-healing wounds
  • Osteomyelitis (bone infections)
  • Thermal burns
  • CO poisoning
  • Smoke inhalation
  • Industrial accidents/crush injuries
  • Necrotizing fasciitis
  • Gas gangrene
  • Decompression sickness/diving accidents