Dr. Puligandla -- Soft Tissue Infections Flashcards
(67 cards)
1
Q
Common and primary goal of surgical team
A
Prevention of surgical site infections in the OR
2
Q
Goal of anti-sepsis
A
Prevent the contamination of the open surgical wound by isolating the operative site from the surrounding non-sterile environment
3
Q
7 uncomplicated soft tissue infections
A
- Cellulitis
- Erysipelas
- Abscess
- Folliculitis
- Furunculosis
- Impetigo
- Ecthyma
4
Q
9 complicated soft tissue infections
A
- 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
Q
Layers of skin involved in cellulitis
A
- Epidermis
- Dermis
6
Q
3 organisms responsible for cellulitis
A
- S. pyogenes
- S. aureus
- H. influenzae
7
Q
3 symptoms of cellulitis
A
- Pain
- Erythema
- Swelling
8
Q
2 treatments for cellulitis
A
- Antibiotics
- Incision and drainage (I+D)
9
Q
Define erysipelas
A
Superficial infection of skin that spreads rapidly and involved dermal lymphatics
10
Q
Cause of erysipelas
A
GAS
11
Q
4 symptoms of erysipelas
A
- Fever
- Pain
- “Aches”
- Adenitis
12
Q
Usual location of erysipelas
A
Legs > face
13
Q
Erysipelas treatment
A
Penicillin G
14
Q
Skin layers involved in skin abscess
A
- Epidermis
- Dermis
- Occasionally deeper structures
15
Q
Usual cause of skin abscess
A
S. aureus
16
Q
Treatment for skin abscess
A
I+D; antibiotics reseved for those with an associated cellulitis
17
Q
4 antibiotics for mild cellulitis
A
- 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
Q
Define felon
A
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
Q
Clinical manifestation of felon
A
Intensely painful throbbing pulp space
20
Q
Potential complciation of felon
A
Pressure can lead to necrosis with spread to tendons, ligaments and bone
21
Q
Treatment for felon
A
- I+D
- Antibiotics against common strep and staph species
22
Q
Define paronychia
A
Infection of skin over the mantle of the nail or of the lateral nail fold
23
Q
Clinical manifestation and potential complication of paronychia
A
Swollen, tender, with progression to felon is untreated
24
Q
Treatment for paronychia
A
- 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
