Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PR3151 Finals > IC14 SSTI > Flashcards

IC14 SSTI Flashcards

1
Q

Types of SSTI and their anatomical sites

A

epidermis - impetigo
dermis - ecthyma, erysipelas
hair follicles - furuncles, carbuncles
SC fat - cellulitis
fascia - necrotising fasciitis
muscle - myositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

protective mechanisms of skin

A
  1. continuous renewal of epidermal layer (shedding of keratocytes and skin microbiota)
  2. sebaceous secretion (inhibit bacteria/ fungi growth)
  3. normal commensal skin microbiome (prevent colonisation and overgrowth of bacteria)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

best defense against SSTI
how does SSTI occur

A

Best defense against SSTI is intact skin

Majority of SSTIs result from the disruption of normal host defenses which allows overgrowth and invasion of the skin by bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

RF of SSTI

A
  1. disruption of skin barrier
    • traumatic: burns, laceration, bites
    • non traumatic: ulcers, tinea pedis
    • impaired venous and lymphatic drainage: venectomy, obesity
    • peripheral artery disease
  2. conditions that predispose to infection (DM, cirrhosis, neutropenia, HIV, immunosuppressed)
  3. hx of cellulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

prevention of SSTI

A
  1. manage predisposing risk factors
  2. maintain skin integrity (good wound care, prevent dry crack skin, tx of tinea pedis)
  3. acute traumatic wound -> do source control (irrigate and debridement)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

diagnosis of SSTI by

A

based on hx and physical examination
- hx taking and recognising RF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when is culture needed for SSTI?
how to collect?

A
  • mild superficial: no need
  • moderate, severe: may need

avoid wound swabs
collect deep in wound after surface cleansed
collect from base of closed abscess
collect by curettage rather than swab/ irrigation

blood culture only for very severe cases with systemic sx/ immunocompromised pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

impetigo: pathogens

A

staph
strep

bullous form caused by toxin producing strains of S.aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ecthyma: pathogens

A

grp A strep (strep pyrogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

non purulent (cellulitis, erysipelas): pathogens

A

beta hemolytic strep (grp A strep most common)
Staph aureus (less common)
water exposure: pseudomonas, aeromonas, vibrio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

purulent (furuncles, carbuncles, skin abscess, purulent cellulitis): pathogens

A

Staph aureus (MSSA/ MRSA)
- HA-MRSA more common in SG
beta hemolytic strep (some)
gram negative, anerobes (skin abscess involving the perioral, perirectal or vulvovaginal areas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

is CA-MRSA related to HA-MRSA

A

no, genetically different
susceptible to oral non betalactams (clindamycin, cotrimoxazole, doxycycline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

RF for CA-MRSA

A
  • contact sports, military personnel, intravenous drug abusers (IVDA), prison inmates
  • overcrowded facilities, close contact and lack of sanitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

definition of HA-MRSA

A

MRSA infection that occurs:
- >48hrs following hospitalisation
- (outside of hospital) within 12 mths of exposure to healthcare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

RF for HA-MRSA in SSTI

A
  • antibiotic use
  • recent hospitalisation or surgery
  • prolonged hospitalisation
  • intensive care
  • hemodialysis
  • MRSA colonisation
  • proximity to others with MRSA colonisation or infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

abx tx for impetigo and ecthyma

A

(impetigo: mild, limited lesions)
topical mupirocin 2% BD x5d

(impetigo, ecthyma: multiple lesions)
PO cloxacillin
PO cephalexin
PO clindamycin

5-7 days

17
Q

culture directed abx tx for impetigo and ecthyma

A

(S.pyrogenes)
PO pen V
PO amoxicillin

(MSSA)
PO cloxacillin
PO cephalexin

5-7 days

18
Q

tx of purulent SSTI (when to give abx)

A

I&D
abx given when:
- unable to drain completely
- lack response to I&D
- immunocompromised
- moderate/ severe purulent SSTI with signs of systemic illness (SIRS criteria, 2 out of 4)
- temp >38, <36
- HR >90
- RR >24
- WBC >12, <4

19
Q

abx for purulent SSTI (mild moderate severe)

A

(mild, eg stye): I&D, warm compress
(moderate, with systemic sx): I&D and
PO cloxacillin
PO cephalexin
PO clindamycin (pen allergy)

(severe) I&D and
IV cloxacillin
IV cefazolin
IV clindaymcin
IV vancomycin (if need cover MRSA)

(MRSA RF)
PO cotrimoxazole, doxycycline, clindamycin
IV vancomycin, daptomycin, linezolid

(empiric gram -‘ve, anaerobes) eg abscess
IV amoxicillin-clavulanate
IV piperacillin-tazobactam
IV carbapenems (for ESBL strains)

5-10 days

20
Q

abx for non-purulent SSTI (mild moderate severe)

A

mild (no systemic sx of infection)
- PO pen V
- PO amoxicillin
- PO cloxacillin
- PO cephalexin
- PO clindamycin (high risk of C.difficle, avoid if possible, unless cover anaerobes or sever pen allergy)

moderate (with systemic sx, some pus, to include MSSA) -> give IV
- IV cloxacillin
- IV cefazolin
- IV clindamycin (pen allergy)
(water exposure) ADD ciprofloxacin to cover pseduomonas, vibrio, aeromonas

severe (eg necrotising infection) - broad coverage
- IV piperacillin-tazobactam
- IV cefepime
- IV meropenem

(MRSA RF) add
IV vancomycin, daptomycin, linezolid

5-10 days

21
Q

why should clindamycin be avoided if possible

A

high risk of C.difficle
used only to cover anaerobes or severe pen allergy

22
Q

non-pharmalogical management of SSTI

A

rest and limb elevation (drainage of edema and inflammatory substances)

treat underlying conditions

23
Q

Monitoring in SSTI

A
  • improvement after 48-72hrs after initiation of abx
  • no progression of lesions or develop complications
  • switch to PO if getting better
  • reassess indication/ choice of abx if pt fails to respond in 2-3 days
  • repeat culture not required
  • no ADR and allergies
24
Q

topical abx for SSTI

A

mupirocin 2% ointment
- controversial, for mild cases that are self limiting
- used for MRSA decolonisation

25
Q

DFI: site of infection

A
  • soft tissue or bone infections below the malleolus
  • areas of DFI: skin ulceration (peripheral neuropathy) and wound (trauma)
26
Q

complications of DFI

A

hospitalisation
osteomyelitis -> amputation

27
Q

DFI: pathophysiology

A

neuropathy
vasculopathy
immunopathy

-> causes ulcer formation/ wounds -> bacteria colonisation -> DFI

28
Q

definition of infection (criteria for infection)
same for both DFI and pressure ulcers

A
  • purulent discharge
  • > =2 signs of inflammation (erythema, warmth, tenderness, pain, induration)
29
Q

DFI and pressure ulcers: microbes

A

(polymicrobial)
mild: staph aureus, beta hemolytic strep

moderate:
+ gram negative bacilli (e.coli, Kleb, Proteus)
+/- Pseudomonas (less common)
+ anaerobes peptostreptococcus, veillonella, bacteroides (ischemic/ necrotic wounds)

severe:
+ gram negative bacilli (e.coli, Kleb, Proteus)
+ Pseudomonas (less common)
+ anaerobes (ischemic/ necrotic wounds)

30
Q

DFI/ pressure ulcers: when to take culture

A

mild: optional
moderate sever: deep tissue culture after cleansing before starting abx, avoid skin swabs
uninfected wounds: no culture

31
Q

pseudomonas aeruginosa RF (DFI)

A

water exposure, warm climate

start empiric when:
- severe infection
- failure of abx not active agianst pseudomonas

32
Q

DFI/ pressure ulcers classification (mild moderate severe)

A

mild:
- Infection of skin and SC tissue +
- erythema: ≤ 2 cm around ulcer +
- No signs of systemic infection

moderate:
- Infection of deeper tissue (bone and joint) +
- erythema: > 2 cm around ulcer +
- No signs of systemic infection

severe:
- Infection of deeper tissue (bone and joint) +
- erythema: > 2 cm around ulcer +
- Signs of systemic infection

33
Q

DFI/ pressure ulcers: abx (mild moderate severe)

A

mild: Staph, Strep
- PO cloxacillin
- PO cephalexin
- PO clindamycin
- (MRSA RF) PO cotrimoxazole, doxycycline, clindamycin

moderate: Staph, Strep, gram neg, anaerobes
- IV amoxicllin-clavulanate
- IV cefazolin/ ceftriaxone + metronidazole
- (MRSA RF) IV vancomycin, daptomycin, linezolid

severe: Staph, Strep, gram neg, Peseudomonas, anaerobes
- IV piperacillin-tazobactam
- IV cefepime + metronidazole
- IV meropenem/ imipenem
- IV cirpofloxacin + clindamycin
- (MRSA RF) IV vancomycin, daptomycin, linezolid

34
Q

DFI/ pressure ulcers: duration of tx

A

no bone involvement
- mild: 1-2 wks
- moderate: 1-3 wks
- severe: 2-4 weeks

bone involved
- surgery removed all infected bone & tissue: 2-5 days
- surgery residual soft tissue: 1-3 weeks
- surgery residual viable bone: 4-6 weeks
- no surgery/ surgery with dead bone: >= 3mths

35
Q

continue abx until wound healing (yes/no)

A

no

36
Q

adjunctive measures for DFI

A
  • debridement
  • off load (reduce weight on the affected area)
  • apply dressing
  • foot care
  • optimal glycemic control
37
Q

pressure ulcers: synergistic interaction btw

A

moisture
pressure
shearing force
friction

38
Q

pressure ulcers RF

A
  • reduced mobility
  • chronic diseases
  • reduces consciousness
  • sensory and autonomic impairment
  • extremes of age
  • malnutrition
39
Q

pressure ulcers adjunctive mesures

A
  • debridement of infected/ necrotic tissues
  • local wound care (normal saline flush)
  • relief of pressures (turn every 2hrs)
  • use air/water bed

PR3151 Finals (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions