Exam 3 Lecture 3 Flashcards by Matti Daniel

Describe the prevalence of SSTI (skin and soft tissue infections)

5.4 million patients have 9.1 million SSTI episodes

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What are some risk factors for SSTI

Hx of SSTI (most common)
Peripheral artery disease patients
CKD
Diabetes mellitus
IV drug use

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What are some complications that SSTI could lead to

Ulcers
Bacteremia
Endocarditis
Osteomyelitis
Sepsis

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What are the 3 different types of SSTIs

Non purulent
Purulent
Necrotizing fascilitis

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What are the non-purulent SSTIs? what does it mean? WHat does it affect?

Cellulitis and erysipelas
Superficial infection infecting only epidermis

NO PUS

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patient presentation of non purulent SSTIs

tender, erythema, swelling, warm to touch, unilateral

-orange peel like skin

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What cultures are considered/recommended for diagnosis of non purulent SSTIs

skin/blood cultures not routinely done
Blood cultures CONSIDERED if: Immunocompromised, animal bites

Blood cultures RECOMMENDED if, severe infection or immunocompromised

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What imaging is used for diagnosis of non purulent SSTIs

CT/MR imaging to rule out necrotizing fascilitis or presence of abscess

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Describe the classification of non purulent SSTIs (EXAM)

Mild- no systemic signs of infection
Moderate- Systemic signs of infection
Severe- Meets SIRS criteria

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What are the SIRS criteria that make non purulent SSTIs severe

Temp>38 or <36
HR>90
RR>24
WBC> 12K or < 4K

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What are causative pathogens for non purulent SSTIs? Most common?

Strep spp
S.pyogenes most common

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What are certain situations in non purulent SSTIs that worry us about MRSA (when would we add on MRSA coverage)

penetrating trauma
Evidence of MRSA elsewhere
Nasal colonization with MRSA
IVDU (IV drug use)
-SIRS/Severe infection (2/4 met)

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What do we use to treat mild non purulent SSTIs

Oral antibiotics
-Pen VK
-Cephalosporin
- Clindamycin

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WHat do we use to manage non purulent SSTIs for moderate infection

IV antibiotics
- Penicillin
- Cefytriaxone
-Cefazolin
- Clindamycin

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What do we use to manage non purulent SSTIs severe infections

emergent surgical inspection/debridement
Empiric antibiotics
Vancomycin + Piperacillin/tazobactam

Culture and susceptibility (blood culture)
- Narrow based on culture and sensitivity

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duration of treatment of non purulent SSTIs

5 days

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What are some purulent SSTIs

Abscess, furuncles and carbuncles

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What are some characteristics of purulent SSTIs

Abscess- collection of pus within dermis and deeper skin tissues

Furuncles (boils)- small abscess that forms around hair follicle

Carbuncles-infection involving several adjacent follicles

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use of cultures in purulent SSTIs

Wound cultures are recommended for all abscess, carbuncles and patients with systemic signs of infection regardless of severity

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classofy purulent SSTIs

same as non purulent

Mild- no systemic signs of infection
Moderate- systemic signs of infection
Severe- SIRS criteria (temp>38, HR>90, RR>24bpm, WBC>12K)

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What are some causative pathogens for Purulent SSTIs

MRSA (most common)
MSSA
Strep spp

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How to manage mild purulent SSTIs

Incision and drainage to clean out pus (no antibiotics)

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How to manage moderate purulent SSTIs

Incision and drainage + Culture and susceptibility

Empiric antibiotics
- TMP/SMX
-Doxycycline

Targeted antibiotics
MRSA- TMP/SMX, Doxycycline
MSSA- Dicloxacin or cephalexin

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How to manage severe purulent SSTIs

Incision and drainage + Culture and susceptibility

EMpiric antibiotics
- IV antibiotics like vancomycin, daptomycin, linezolid

Targetted antibiotics
MRSA- see empiric therapy
MSSA- Nafcillin, cefazolin, clindamycin

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Describe nexrotizing fascilitis

MEDICAL EMERGENCY associated with high morbidity and mortality

presentation of necrotizing fascilitis

Profound systemic toxicity Change in color of skin of maroon/purple/black, edema severe pain

Use of cultures in necrotizing fascilitis

Blood cultures are recommended given severe infection Wound cultures likely obtained from surgery

Use of imaging in necrotizing fasciitis

CT/MR imaging done to confirm necrotizing fasciilitis or presence of abscess

Causative opthogens for necrotizing fasciitis

Number 1 cause- strep species, specifically s. Pyogenes 2. Anaerobes 3. staph aureus

What does the management of necrotizing fascilitis look like

Emergent surgical Inspection/debridement Empiric antibiotics -Vanc + Piperacillin/tazobactam Culture and susceptibility Targeted antibiotics S. pyogenes- PCN + clindamycin Polymicrobial Vanc + Piperacillin/tazobactam

After culture and susceptibility testing of necrotizing fascilitis, what do we use to target S. pyogenes?

PCN (penicillin) + Clindamycin

After culture and susceptibility testing of necrotizing fascilitis, what do we use to target polymicrobial infection

Vamcomycin + Piperacillin/tazobactam

What are some other SSTIs not covered under purulent, non purulent or necrotizing fasciitis

Impetigi and animal/human bites

What are some characteristics of impetigo? Patient presentation?

Highly contagious superficial skin infection caused by abrasion Small, painless, fluid filled vesicles that can lead to thick golden crusts. systemic signs of infection are rare

How to treat impetigo with few lesions

Mupirocin topical X 5 days

How to treat impetigo with many lesions/outbreak

Dicloxacillin or cephalexin

How to treat impetigo with streptococcus only

Penicillin

How to treat impetigo with B lactam allergy or founf to have MRSA

Doxyxyxline Clindamycin TMP/SMX

Patient presentation in human/anima bites? Culture use?

Cat bites- deep, sharp puncture wound Dog/human- Cellulitis signs and symptoms Blood cultures are recommended in animal bites

how do we treat an established infection after an animal/human bite. (redness, looks infected)

Augmentin (amox clav)

When would we use pre emptive therapy for animal/human bite

Immunocompromised Asplenia Moderate to severe bites Bites on face/hand Bites that penetrate joints

What is the duration for treatment of established infection? Preemptive infection?

X7-14 days for established 3-5 days for preemptive treatment

What do we use for established infection due to animal/human bite if we can not use amox/clav

2nd/3rd gen cephalosporin + Anaerobic coverage

What do we use for Animal/uman bites if B lactam allergy

Cipro/levo + anaerobic coverage OR moxi

Risk factors for diabetic foot infections

Neuropathy Angiopathy/ischemia Immunologic defects Poor wound healing

patient presentation for diabetic foot infections

Typical local signs of infection +/- purulent secretions, foul odor

For diabetic foot infections, how are wound cultures, bone cultures and blood cultures handled

Wound- Not recommended for mild infection Bone cultures- typically obtained following I and D Blood culture- may be considered

For infected ulcers of diabetic foot infections, what are common pathogens

S. aureus Streptococci spp

For chronic infected ulcers of diabetic foot infection, what are common pathogens

S. aureus streptococci spp Enterobacterales spp Anaerobes

What are macerated ulcer due to soaking common pathogens

P. aeruginosa S. aureus. Streptococci spp

Risk factors in diabetic foot infection for MRSA

Previous MRSA infection within past uear Local MRSA prevalence > 30-50% Recent hospitalization Failed non-MRSA antibiotics

Risk factors for diabetics foot infection for pseudomonas

- history of psedomonas infection - Soaking feet in water - Warm climate -Severe infection - failed non psuudomonas antibiotics

FOr exam, if question says indianapolis ED, we always ADD MRSA coverage

Overall management for diabetic foot infection

Surgical intervention Glycemic control Antibiotics

What are bugs that we need to cover for mild diabetic foot infections

MSSA, streptococci spp

First line treatment for mild diabetic foot infections. Duration.

Dicloxacillin, cephalexin, clindamycin. 1-2 weeks

What to use in mild diabetic foot infections if patient was on recent antibiotics

Amox/clav Levofloxacin or moxifloxacin

What to use in mild diabetic foot infections if MRSA risk factors are present

Switch to sulfamethoxazole/trimethoprim Doxycycline

For moderate diabetic foot infections, what organisms need to be covered

MSSA, strep spp, enterobacteriaceae, anaerobes

What are 1st line therapies for moderate diabetic foot infections? Duration

Moxifloxacin, amoxicillin/clavulanate, cipro/levo + clindamycin or metronidazole 2-3 wks

For moderate diabetic foot infections with pseudomonal risk factors what should we switch to

Cipro/levo + clindamycin or metronidazole

For moderate diabetic foot infections with MRSA risk factors, what agents should we add

Doxycycline, linezolid, vancomycin, TMT/SMX

For severe diabetic foot infections, what organisms do we need to cover

MSSA, streptococci spp, enterobacteriaceae, anaerobes pseudomonas

What is 1st line for severe diabetic foot infection? Duration?

Piperacillin/tazobactam, carbapenem, cefepine + Clindamycin or metronidazole 2-3 wks

MRSA drugs for severe diabetic foot infections

Add vancomycin, lineolid, daptomycin

Exam 3 Lecture 3 Flashcards

(66 cards)