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Skin & Soft Tissue Infection > Skin And Soft Tissue > Flashcards

Skin And Soft Tissue Flashcards

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1
Q

signs and symptoms of systemic toxicity

A
  • Fever or hypothermia
  • tachycardia
  • hypotension
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2
Q

treatment for outpatients with mild-moderate SSTI’s

A

empiric treatment: check pt 24-48 hours

  • PCN
  • cephalosporins
  • and/or clindamycin
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3
Q

what is the outer most protective layer of the skin?

A

stratum corneum

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4
Q

Define PRIMARY skin infection

A

involves normal healthy skin

- typically one pathogen

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5
Q

Define SECONDARY skin infection

A

Involves damaged skin

  • polymicrobial
    ex: Bed ridden patients typically get bed sores/ulcers–> these get infected
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6
Q

5 factors for infections

A
  1. breakdown of skin integrity
  2. vascular insufficiency
  3. indwelling devices
  4. immunocompromised
  5. poor hygiene
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7
Q

Describe an uncomplicated SSTI and list the 5 types.

A
  • Typically mild, superficial
    1. folliculitis
    2. fruncles
    3. carbuncles
    4. impetigo
    5. uncomplicated cellulitis
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8
Q

what is folliculitis

A

superficial infection surrounding the hair follices

- inflammaed

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9
Q

what are the pathogens associated with folliculitis

A

staph aureus

pseudomonas aeruginosa

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10
Q

Where are people prone to getting psuedomonas folliculitis and why?

A

in the hot tub bc pseudomonas are water loving bugs

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11
Q

Clinical presentations of folliculitis

A
  • papules: 48 hrs after exposure
  • –> maybe pus
  • multiple clustered lesions
  • pruritis possibly —> swimmer’s itch
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12
Q

what are the two local managemnt topical therapy options for folliculitis

A
  • Warm saline compresses

- Topical antimicrobials

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13
Q

what are topical antimicrobial options for folliculitis

A
  • clindamycin
  • erythromycin
  • mupirocin ( bactroban)
  • Gentamicin (pseudomonas)
  • antifungals (candida sp.)
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14
Q

what topical antimicrobial is used for pseud. (brand/generic) biotches

A

mupirocin (BACTROBAN)

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15
Q

is folliculiitis a progressive infection?

A

NO derpp

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16
Q

Define Furuncle. aka….

A

Boils. inflammatory nodule involving a hair follicle

—> extension of folliculitis from hair shaft to dermis

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17
Q

where are furuncles present? more common?

A

anywhere on hairy skin. more common in areas of friction and perspiration.

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18
Q

who’s is the loosest?

A

Kori’s bahahaha

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19
Q

Define carbuncles?

A

furuncle extended to the subcutaneous tissue. a cluster of subcutaneous abscesses.

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20
Q

systemic symptoms of carbuncles

A

fever, chills, malaise, bacteremia

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21
Q

what bacteria is most likely the cause of carbuncles and furuncles. from where does it enter the body?

A

staph.

nasal carriage

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22
Q

Where are carbuncles typically present

A

back of the neck

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23
Q

treatment options for carbuncles and furuncles

A
  • moist heat —> drainage
  • surgical incision to drain (large/multiple)
  • Oral ABX therapy 5-10 days
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24
Q

When will you use ABX for furuncles and carbuncles

A

if fever or extensive cellulitis documented

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25
what ABX for carbuncles or furuncles?
dicloxicillin clindamycin (DOC for PCN allergy) cephalexin
26
what Antibacterial soaps help to prevent a recurrence of furuncles or carbuncles
- clorhexidine | - hexachloraphene
27
what intranasal ABX help to prevent a recurrence of furuncles or carbuncles
- Mupirocin ointment for nasal carriage | - Bacitracin
28
What oral antibiotic is given to prevent a recurrence? is it given prophylactically?
No. CLINDAMYCIN is given when theres an outbreak
29
Nickname of Erysipelas
Saint Anthony's Fire
30
What is erysipelas?
acute spreading skin infection. - -->involves the superficial dermis and lymphatics - --> spreads rapidly causing impaired lymphatic drainage.
31
What are the common pathogens that cause erysipelas?
Group A & B streptococcus
32
erysipelas caused by group b strep is commonly present in what type of people?
Newborns
33
who is more prone to erysipelas?
- infants - young children - old people - pts with nephrotic syndrome
34
where on the body is erysipelas present?
lower extremities and sometimes face (around the eyes)
35
describe the rash of erysipelas?
bright red, edematous (edema), indurated (hard) and demarcated (boundary), painful, elevated border (different from cellulitis)
36
Common signs of erysipelas
fever and leukocytosis
37
Mild to moderate uncomplicated erysipelas treatment
- Procaine PCN G - PCN VK * PCN allergy - Clindamycin (7-10 days)
38
Serious complicated erysipelas treatment
-Aqueous PCN
39
define impetigo?
superficial vesticulopustular skin infection
40
where does impetigo occur?
on exposed area of the face and extremities
41
what pathogens causes impetigo?
staph aureus and or group A strept
42
what are common causes of impetigo?
- warm climates - poor hygiene - minor skin trauma
43
name the three types of impetigo
- non bullous - bullous - Ecthyma
44
Describe Non-bullous impetigo.
most common form that begin as papules and progress to vesicles surrounded by erythema
45
describe bullous impetigo. (compare to nonbullous, what pathogen?)
fewer lesions when compared to nonbullous, commonly on the trunk, forms bullae that rupture into light brown crusts, caused by S. AUREUS but not MRSA
46
Describe ecythema impetigo and what pathogen causes it
ulcerative impetigo caused by group A STREPTOCOCCI | takes place in the epidermis and dermis
47
explain how impetigo manifests
start of small fluid filled vesicles, they rupture leading to crusty golden yellow lesions.
48
treatment of impetigo for small # of lesions w/o bullae
DOC: topical mupirocin 2% ointment | - retapamulin 1% ointment ( for MRSA resistance)
49
treatment for impetigo for numerous lesions or not responding to topical therapy
- dicloxacillin - cephalexin or cefadroxil (1st generations) - clindamycin
50
what medications are resistant and should be avoided for impetigo
FQ and macrolides
51
What is cellulitis
acute infection that spreads from epidermis to deep to deep into the dermis
52
the most important clinical presentations of cellulitis
area RED HOT & SWOLLEN
53
what are the two common pathogens that cause cellulitis
staph aureus and strep pyogenes
54
describe cellulitis caused by staph aureus
``` pus producing slow moving ---> VERY VIRULENT PORTAL OF ENTRY positive cultures moderate pain no lymphatic streaking ```
55
describe cellulitis caused by strep pyogenes
``` limited pus advances rapidly dark red pigmentation no portal entry rarely positive cultures EXTREMELY PAINFUL lymphatic streaking---> bacteria spreads through the bloodstream and you see it travelling through the lymphs to your heart ```
56
non-pharm therapy for cellulitis
proper local wound care is essential | pus must be removed if present
57
Cellulitis empiric treatment (mild-mod gram + w/o systemic symptoms) oral, IV, PCN allergy
Oral: - dicloxacillin (anti-staph) OR cephalexin (1st) IV : (if systemic symptoms present) - Nafcillin (anti-staph) OR cefazolin (1st) PCN allergy: cephalexin cefazolin clindamycin
58
Cellulitis empiric treatment (polymicrobial and anaerobes)oral, IV, PCN allergy
Oral: Augmentin OR Bactrim IV: Nafcillin OR Unasyn PCN: FQ +/- clindamycin AG +clindamycin
59
Cellulitis empiric treatment (mod - severe)
IV ONLY zosyn OR timentin (cover pseudomonas) Carbapenems +/- vancomycin (to cover MRSA)
60
gram negative cellulitis treatment
give 3rd generation cephalosporin OR FQ | PCN allergy: FQ plus clindamycin or vancomycin
61
Risk factors for CA-MRSA
``` HX of MRSA high prevalence in community crowded living contact sports shaving ```
62
list medications for severe MRSA
``` IV ONLY daptomycin (use when breakpoint <1) tigecycline (not for bacteremia) linezolid quinupristin/dalfopristin vancomycin (preferred for severe cases) (DOC for HA MRSA) telavancin ```
63
list medications for mild MRSA
``` PO only Bactrim (if clinda resistant) (give Beta lactam also if ----> used for community acquired cellulitis present) clindamycin doxycycline rifampin (ADD on ONLY) ```
64
types of complicated SSTIs (CSSTIs)
Deep tissue infection - abscesses - necrotizing wounds(cellulitis and fascilitis) - bites - burns - surgical wounds - ulcers
65
abscess treatment and pathogens that cause them
drainage IVDU ( staph, strep, pseudomonas,oral anaerobes) consider CA MRSA
66
describe Necrotizing fascitis (type 1 and 2)
progressive fatal flesh eating bacteria type 1: polymicrobial (mixed anaerobic/aerobic) type 2: Group A strep ----> associated with toxic shock syndrome
67
Treatment of necrotizing fascitis type 1 and 2
aggressive surgical intervention empiric IV ABX Type 1: carbapenems or BLBLI 3rd gen. ceph + clinda or metronidazole FQ (cipro) + clinda or metronidazole ADD vanco maybe for MRSA Type2: high dose PCN plus Clinda
68
Empiric treatment for diabetic foot inf (Mild)
1st generation ceph amox/clav acid TMP/SMX FQs
69
Empiric treatment for diabetic foot inf (Severe)
``` ischemia present - wound debridement/amputation carbapenems or BLBLI +/- vanco, linezolid, dapto ----> metronidazole or clindamycin + 3rd/4th ceph OR FQs ```

Skin & Soft Tissue Infection (1 decks)

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