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PR3151 > IC14 SSTI > Flashcards

IC14 SSTI Flashcards

1
Q

What are the common reasons for SSTIs?

A
  1. Disruption of normal host defense
  2. Overgrowth of microbes and skin invasion
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2
Q

What are the risk factors for SSTIs?

A
  1. Disruption (traumatic, non -traumatic, impaired venous and lympatic drainage, peripheral artery diseases)
  2. Predipsoed conditions (i.e. DM, HIV, transplantation and immunosuppresive medications)
  3. Cellulitis history
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3
Q

What are ways to prevent SSTIs?

A
  1. Managed predisposing conditions
  2. Maintain skin integrity (i.e. good wound care)
  3. Acute traumatic wound - debride and irrigation
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4
Q

What is the clinical presentation of impetigo which affects the epidermis?

A
  1. Erythematous papules
  2. Vesicles + pustules
  3. Honey coloured crusts on erythematous base due to rupturing of no.2
  4. Well localised
  5. Common on face and extremities
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5
Q

What is the clinical presentation of ecthyma (ulcerative impetigo) which affects the dermis?

A
  1. Itch
  2. Lesions extends deep into dermis
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6
Q

What is the clinical presentation of furuncle (boil)?

A
  1. Infection of hair follicle
  2. Purulent material extending in SQ tissues
  3. Abscess
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7
Q

What is the clinical presentation of carbuncles?

A
  1. Coalesce of furuncle
  2. Extend in SQ tissues
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8
Q

What is the clinical presentation of skin abscesses?

A
  1. Collection of pus within dermis and deeper skin tissues.
  2. Abscesses are painful , tender, fluctuant
  3. erythematous nodules
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9
Q

What is the clincial presentation of cellulitis which affects the SQ fats?

A
  1. Acute, diffuse, spreading, non-elevated, poorly demarcated
  2. Unilateral, rapid progression/ onset and lower extremities
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10
Q

What is the clinical presentation of erysipelas which affects the dermis?

A
  1. fiery red, tender
  2. Painful plagues
  3. Well demarcated edges
  4. Common on face and lower extremities
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11
Q

How should culture be collected?

A
  1. Deep in wound after surface is cleansed
  2. Base of closed abscess
  3. By curettage
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12
Q

When should blood culture be taken?

A
  1. Immunocompromised
  2. Severe cases with marked systemic symptoms of infection
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13
Q

What is the bacteria that causes impetigo?

A

Staphlococci and Streptococci

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14
Q

What is the bacteria that causes ecthyma?

A

Group A streptococci

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15
Q

What are the antibiotics option avaiable for impetigo (mild, limited lesions)?

A

Topical mupirocin BID for 5 days

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16
Q

What are the antibiotics option avaiable for impetigo and ecthyma (multiple lesions)?

A

PO cephalexin or cloxacillin

Penicillin allergy (PO clindamycin)

Culture directed (S.pyogenes): PO penicillin V, amoxicillin

Culture directed (MSSA): cephalexin or cloxacillin

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17
Q

What is the duration of treatment of impetigo and ecthyma?

A

5 to 7 days

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18
Q

What is the bacteria that cause non-purulent cellulitis or erysipelas

A

Commonly β hemolytic streptococcus (group A - S.pyogenes) - common

Others: S.aureus, Aeromonas, vibrio, vulnificus, pseduomonas

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19
Q

What are the antibiotics for mild, non purulent cellutitis and erysipelas?

A

Penicillin V, Cephalexin, Cloxacillin

Penicillin allergy: Clindamycin

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20
Q

What are the antibiotics for moderate, with some purulence cellutitis and erysipelas?

A

Cefazolin, cloxacillin

Penicillin allergy: Clindamycin

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21
Q

What are the antibiotics for severe cellutitis and erysipelas?

A

IV: Piperacillin Tazobactam, cefepime, meropenem

MRSA: IV vancomycin, daptomycin and linezolid

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22
Q

What is the bacteria that causes purulent furuncles, carbuncles, skin abscesses, purulent cellulitis?

A

S.aureus (main)

Others: β-hemolytic strptococcus, gram neg and anaerobes

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23
Q

What are the components in the SIRS criteria?

A

Temperature: <36 or > 38 degree celcius
HR: 90bpm
RR: 24 bpm
WBC: >12x10^9/Lor <4x10^9/L

At least 2 out of 4 must be fulfilled

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24
Q

What is the mainstay treatment for purulent SSTIs?

A

Incision and drainage

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25
Q

When is adjucntive systemic antibiotics given?

A
  1. Unable to drain completely
  2. Lack of response to I&D
  3. Extensive disease involving several sites
  4. Extremes of age
  5. Immunosuppressed
  6. Signs of systemic illness
  7. IV if severe
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26
Q

What is the treament for mild purulent SSTIs?

A

I&D
warm compress to promote drainage

27
Q

What is the treatment for moderate purulent SSTIs?

A

I&D
Oral antibiotics (cloxacillin or cephalexin; if penicillin allergy, clindamycin)

28
Q

What is the treatment for servere purulent SSTIs?

A

I&D
IV antibiotics (cloxacillin or cefazolin; if penicillin allergy, clindamycin or vancomycin - MRSA also)

29
Q

What are the antibitoics options for MRSA?

A

Co-trimozaxole, doxycycline, clindamycin, vancomycin, daptomycin, linezolid

30
Q

What are the antibiotics options for Gram negative and anaerobes?

A

Amoxicillin-clavulanate

If hospitalised, piperacillin tazobactam
If ICU septic shock, carbapenems

31
Q

What is the duration of treatment for purulent SSTIs?

A

5 to 10 days

32
Q

What are some non-pharmacological methods for non-purulent cellulitis and erysipelas?

A
  1. Limb elevation and rest
  2. Treat underlying conditions
33
Q

Is repeat culture required if there is response?

A

No

34
Q

Mupirocin is good against ______ cocci?

A

aerobic gram negative

35
Q

Diabetic foot infection is only counted infected if there is ____ discharge and ≥ ___ signs or symptoms of inflammation.

A

purulent, 2

36
Q

What are the signs and symptoms of inflammation in DFI?

A
  1. Erythema
  2. Warmth
  3. Tender
  4. Warmth
  5. Induration
37
Q

What is the pathophysiology of DFI?

A
  1. Neuropathy
  2. Vasculopathy
  3. Immunopathy

All three results in ulcer formation, wounds, bacteria colonize, penetrate and proliferate

38
Q

What is the presentation of DFIs?

A
  1. superificial ulcer, mild erythema
  2. deep tissue infection, extensive erythema
  3. infection of bone and fascia, purulent discharge
  4. localised gangrene
39
Q

What is the microbiology of DFIs and pressure ulcers?

A

Mostly polymicrobial (S.Aureus and streptococcus)

Gram negative bacilli and other organism such as E.coli, Kleb, Proteus

Anerobes in necrotic wounds such as Bacteriodes, Peptostreptococcus, Veillonella

40
Q

Are cultures only recommended in moderate to severe DFI and pressure ucler?

A

Yes

41
Q

What is the clinical presentation for mild DFT and pressure ucler ?

A

Affects skin and SQ tissue
Erythema ≤ 2cm around ucler
No signs of systemic infection

42
Q

What bacteria should be covered in mild DFT and pressure ucler?

A

Streptococcus and S.aureus

43
Q

How is mild DFT and pressure ucler treated?

A

PO: Cephalexin, cloxacillin, clindamycin

MRSA risk: PO cotrimoxazole, clindamycin, doxycycline

44
Q

What is the clinical presentation for moderate DFT and pressure ucler ?

A

Affects deeper tissue such as bones OR joints
Erythema > 2cm around ucler
No signs of systemic infection

45
Q

What bacteria should be covered in moderate DFT and pressure ucler?

A

Streptococcus and S.aureus, gram negative (+/- P.areuginosa) and anaerobes

45
Q

How is moderate DFT and pressure ucler treated?

A

IV: Amoxicillin-calvulanate, cefazolin or ceftriaxone + metronidazole

MRSA: Vancomycin, daptomycin and linezolid

46
Q

What is the clinical presentation for severe DFT and pressure ucler ?

A

Affects deeper tissue such as bones OR joints
Erythema > 2cm around ucler
Signs of systemic infection

47
Q

What bacteria should be covered in severe DFT and pressure ucler?

A

Streptococcus and S.aureus, gram negative (+/- P.areuginosa) and anaerobes

48
Q

How is severe DFT and pressure ucler treated?

A

IV: Piperacillin-tazobactam, cefepime + metronidazole, meropenem, ciprofloxacin + clindamycin

MRSA: Vancomycin, daptomycin and linezolid

49
Q

What is the duration of treatment for mild infection DFI and pressure ulcer, no bones infected?

A

1 to 2 weeks

50
Q

What is the duration of treatment for moderate infection DFI and pressure ulcer, no bones infected?

A

1 to 3 weeks

51
Q

What is the duration of treatment for severe infection DFI and pressure ulcer, no bones infected?

A

2 to 4 weeks

52
Q

What is the duration of treatment for surgical removal of infected bones and tissues for DFI and pressure ulcer?

A

2 to 5 days

53
Q

What is the duration of treatment for surgical removal with residual infected soft tissues for DFI and pressure ulcer?

A

1 to 3 weeks

54
Q

What is the duration of treatment for surgical removal with residual viable bones for DFI and pressure ulcer?

A

4 to 6 weeks

55
Q

What is the duration of treatment for no surgery or surgery for resdiual dead bone for DFI and pressure ulcer?

A

≥ 3 months

56
Q

What are the adjunctive measures for DFI?

A

Wound care (debride, raise leg, remove weight, apply dressing that remove exudate and promote healng environment)

Foot care

Glycemic control

57
Q

What are the four factors that lead to pressure uclers?

A

moisture, pressure, shear force, friction

58
Q

What are the risk factors for pressure ulcer?

A

Decrease mobility
Debilitated by severe chronic diseases
Decreased consiousness
Sensory and autonomic impairment
Age exmtremities
Malnutrition

59
Q

What are the presentation of stage 1 pressur ulcer?

A

Epidermis abrasion, irregular area of tissur swelling, no open wounds

60
Q

What are the presentation of stage 2 pressur ulcer?

A

Extend through dermis and open wound

61
Q

What are the presentation of stage 3 pressur ulcer?

A

Deep into SQ fats, open sore, ulcer

62
Q

What are the presentation of stage 4 pressur ulcer?

A

Muscle, bones, deep sore/ ulcer

63
Q

What are the adjunctive treatment for pressure ulcer?

A

Debride infected or necrotic tissue, local wound care, pressure relief

PR3151 (2 decks)

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