Exam 3 - Skin/Soft Tissue Infections Flashcards Preview

Therapeutics V Spring 2019 (P3 Spring) > Exam 3 - Skin/Soft Tissue Infections > Flashcards

Flashcards in Exam 3 - Skin/Soft Tissue Infections Deck (68):
1

Most skin and soft tissue infections are caused by what bugs?

Beta hemolytic streptococci
or
Staphylococcus aureus

2

what does SSTI stand for

skin and soft tissue infections

3

what are the 3 main layers of skin

outer most --> inner most layers
epidermis -- dermis -- subcutaneous tissue

4

epidermis, dermis or subcutaneous tissue?

non-vascular layer composed of continuously dividing cells and the stratum corneum

epidermis
(also the outermost layer)

5

epidermis, dermis or subcutaneous tissue?

consists of connective tissue, blood vessels, lymphatics, sensory nerve endings, sweat and sebaceous glands, hair follicles and smooth muscle fibers

dermis
(also layer directly beneath epidermis)

6

epidermis, dermis or subcutaneous tissue?

layer of loose connective tissue primarily containing adipose cells

subcutaneous tissue
(innermost layer)

7

what is fascia and where is it located?

located beneath subcutaneous tissue layer -- separates skin from underlying muscle
(deep fascia forms sheath that surrounds the muscle)

8

what is some important patient history info to gather about SSTIs?

immune status
geographic locale
travel history
recent trauma or surgery
lifestyle
hobbies
animal exposure/bites
previous antimicrobial therapy

9

Impetigo symptoms?

superficial skin infecetions: maculopapular lesions with a dried, honey colored crust -- usually on face around mouth

10

Impetigo:
Typically/most common form is Non_____ type
other is ______ type

Non-bullous type
or
Bullous

11

Impetigo
Non-Bullous type: usually what bug causes infection?
vs
Bullous type: usually what bug causes it?

Non-bullous -- Group A strep

Bullous: MSSA

12

Risk factors for impetigo?

KIDS!!
Hot/humid climates
poor hygiene/day care settings (aka kids)
crowing
malnutrition
diabetes

13

Topical treatment for impetigo

Mupirocin 2% or retapamulin 1% ointments BID x5

14

Oral options for Impetigo (systemic treatment)

Dicloxacillin
Erythromycin (good if PCN allergy)
Clindamycin (good if PCN allergy)
Cephalexin
Amox/Clav

15

Symptoms of Cellulitis?

Rapidly spreading erythema,
edema
tenderness
warmth in skin with a poorly defined border

16

common pathogenesis of cellulitis?

introduced to skin during trauma, lacerations, abrasions --- FISSURED TOE WEBS FROM FUNGAL INFECTIONS OF FEET, cracks in dry skin

aka any cut in the skin......

17

What patients are at risk for cellulitis

anybody!! happens in healthy ppl because just any cut can cause this

(common in IV drug users, arterial/venous insufficiency, pts with diabetes or obesity, immunocompromised pts)

18

Erysipelas:
variant of ______ -- caused by ____________
has ________ appearance; often involves the face
Only in _____ dermis and has clearly ________

variant of cellulitis -- caused by beta hemolytic streptococci
has peau d' orange appearance; often involves the face
Only in upper dermis and has clearly defined borders

19

most likely causative pathogens for cellulitis

S. Aureus (including MRSA)
Streptococus Pyogenes (group A strep)

20

who is at hight risk for CA-MRSA with cellulitis infections

recent tattooed people
inmates
injection drug users
Native American Populations
Gat men
Contact sport participants
kids

21

Patients with skin infections due to CA-MRSA often have cellulits AND ________

abscess/pustules

22

why does CA-MRSA cause cellulitis AND abscesses/pustules?

CA-MRSA has genes for PVL (a virulence factor) been associated with TISSUE NECROSIS and ABSCESS FORMATION

23

CA-MRSA with cellulitis often susceptible to what drugs

doxycycline
Clindamycin
SMZ-TMP

24

Treat cellulitis like it has MRSA when?

in populations specified before like: recent tattooed people
inmates
injection drug users
Native American Populations
Gat men
Contact sport participants
kids

AND

if pt has an abscess!!

25

Cellulitis Treatment:
if no abscess or if gram stain/culture is inconclusive: empiric therapy should cover what bugs?

Group A strep AND staphylcoccus aureus

26

Cellulitis Treatment:
What drugs should be used for MILD infection/no MRSA suspected

dicloxacillin
cephalexin

27

Cellulitis Treatment:
What drugs should be used for MILD infection/MRSA suspected

SMZ-TMP
Clindamycin
Linezolid

28

Cellulitis Treatment:
What drugs should be used for MODERATE-SEVERE infection/no MRSA suspected

Nafcillin
Cefazolin

29

Cellulitis Treatment:
What drugs should be used for MODERATE-SEVERE infection/MRSA suspected

Vanc
Linezolid

30

Cellulitis Treatment:
What drugs should be used if patient has severe PCN allergy

Clindamycin
Vanc
Linezolid

31

Cellulitis Treatment:
how long to treat it

minimum 5 days!!

32

Cellulitis Treatment:
DIRECTED therapy towards strep. pyogenes --- use what drug

PCN

33

Cellulitis Treatment:
DIRECTED therapy for MRSA

Vanc, Clindamycin, or SMZ-TMP

34

Cellulitis Treatment:
DIRECTED therapy for Gram - bacilli

3rd gen cephs
extended spectrum PCN (piperacillin
FQs

35

Cellulitis Treatment:
DIRECTEd therapy for Polymicrobial with anaerobes

beta lactamse inhibitor combo (pip tazo)
OR
3rd gen ceph
OR
FQ w/ metronidazole
OR
Carbapenem alone.......
wtffff

36

Necrotizing Fasciitis:
Symptoms?

INTENSE pain
wooden hard
systemic toxicity!!

37

Necrotizing Fasciitis:
Risk factors?

same as cellulitis!!
like any cut....

38

Necrotizing Fasciitis:
Common bugs?

Monomicrobial: group A strep (streptococcus pyogenes)
Polymicrobial: Gram - bugs AND anaerobes

39

Necrotizing Fasciitis:
Treatment -- must have what two things

SURGICAL intervention (surgical debridment)
and Broad AF spectrum drug coverage

40

Necrotizing Fasciitis:
Empiric Therapy?

Vanc + Pip/Tazo
meropenem
ceftriaxone/metronidazole
fluoroquinolone/metronidazole

41

Necrotizing Fasciitis:
Directed therapy for strep pyogenes

PCN + Clindamycin (suppress toxin production)

42

Necrotizing Fasciitis:
Directed therapy for clostridium

PCN + Clindamycin (suppress toxin production)

43

Necrotizing Fasciitis:
Directed therapy for Staph Aureus?

MSSA: Nafcillin/Cefazolin
MRSA: Vanc

44

what does DFI stand for

diabetic foot infection

45

why are diabetics at increased risk for DFIs??

bc neuropathy, angiopathy with ischemia, immune system defects, decreased wound healing

46

Not all diabetic ulcers/wounds are infected:
to be considered infected they have to have at least __#__ signs and symptoms of inflammtion

What are the signs/sypmtoms

# at least 2

redness, warmth, swelling/induration tenderness or pain

47

what system is used to classify diabetic foot infections

PEDIS Grade

48

A PEDIS grade of _____ is considered mild infection seveirty

2

49

A PEDIS grade of _____ is considered moderate infection severity

3

50

A PEDIS grade of _____ is considered severe infection severity

4

51

what does SIRS stand for

Systemic inflammatory response signs

52

T or F: Abx alone are great for treating DFIs

false!!
need appropriate wound care (debridement)
Tight glycemic control
Optimizing blood flow too

53

Difference between PEDIS Grade 2 (mild) vs PEDIS Grade 3 (moderate)?

2: local infection -- only skin/SQ tissue -- erythema is b/w 0.5 - 1.9 cm around ulcer

3: local infection -- deeper than skin and SQ tissue -- erythema is > 2 cm around ulcer

BOTH DO NOT HAVE SIRS

54

what are examples of SIRS

Temperature > 38 C or < 36 C
HR > 90 bpm
RR > 20 breaths/min
WBC > 12,000 or < 4,000

55

What criteria makes a DFI and PEDIS Grade 4/Severe?

Local infection described above + at least 2 or more SIRS!!

56

If MILD DFI:
Covering what bacteria?

beta hemolytic streptococic
and
Staph aureus

57

If MODERATE DFI:
Covering what bacteria?

Same as mild (beta hemolytic streptococic
and Staph aureus)
+ consider ENTEROBACTERIACEAE

58

If SEVERE DFI:
Covering what bacteria?

Same as moderate (beta hemolytic streptococic
and Staph aureus and ENTEROBACTERIACEAE)
+ MRSA, Pseudomonas and Anaerobes

59

want Pseduomonas coverage for DFIs when?

if pt has soaked their foot in water!
also if pt is failing therapy w/out pseudomonal coverage or if pt has SEVERE DFI

60

Duration of Therapy for DFIs:
Mild infections?

1- 2 weeks

61

Duration of Therapy for DFIs:
Moderate infections?

1 - 3 weeks

62

Duration of Therapy for DFIs:
Severe infections?

2- 4 weeks

63

Duration of Therapy for DFIs:
if bone involvement?

4 - 6 weeks

64

Empiric Therapy for DFIs:
Mild Infection?

PO Cephalexin OR
PO dixcloaxillin OR
PO Augmentin

or PO Clindamycin or PO SMX/TMP

65

Empiric Therapy for DFIs:
Moderate infection?

IV cefazolin
(IV ceftriaxone alone if enterbacteriaceae suspected)

add PO metronidazole if anaerobes suspected

66

Empiric Therapy for DFIs:
Severe infection?

BROAD SPEC AS HELL:

VANC + Pip/Tazo
or VANC + meropenem
or VANC + Ceftazidime + metronidazole
or VANC + Cefepime + metronidazole
or VANC + FQ + metronidazole

67

what organisms are we trying to cover for empiric therapy of severe DFIs?

strep, staph (MSSA and MRSA), enterbacteriaceae, pseudomonas, and anaerobes....

68

Non-antibiotic options for treatment of DFIs?

appropriate wound care!! debridement/stay off it/bed rest
tight glycemic control
optimizing blood flow (smoking cessation/stents..)