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PHRM 865 > Skin and Soft Tissue Infection/Diabetic Foot Infections > Flashcards

Skin and Soft Tissue Infection/Diabetic Foot Infections Flashcards

(54 cards)

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1
Q

What are the risk factors of SSTI?

A

hx of SSTI (most common), PAD, CKD, DM, IV drug use

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2
Q

What are the complications of SSTI?

A

increase risk of ulcers, bacteremia, endocarditis, osteomyelitis, sepsis

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3
Q

What are the types of SSTIs?

A

non-purulent, purulent, and necrotizing fasciitis
staph and strep are most common pathogens found on human skin

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4
Q

What are the types of non-purulent SSTIs?

A

cellulitis and erysipelas

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5
Q

What are the characteristics of non-purulent SSTIs?

A

NO pus
really only impacts epidermis, superficial infection

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6
Q

What is the patient presentation of non-purulent SSTIs?

A

only localized signs of infection; tender, erythema, swelling, warm to touch, orange peel-like skin

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7
Q

What cultures should you get done in non-purulent SSTIs?

A

skin/blood cultures not routinely used (b/c culture would be contaminated with normal skin flora)
blood cultures recommended IF: immunocompromised, severe infection, animal bites

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8
Q

What imaging should be done in non-purulent SSTIs?

A

CT/MRI to rule out necrotizing fasciitis or presence of abscess
reserved for pts not improving on therapy

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9
Q

What is the classification of non-purulent SSTIs?

A

mild - NO systemic signs of infection
moderate - systemic signs of infection
severe - meets SIRS criteria (need to have 2 out of the 4): temp >38C or <36C, HR >90 bpm, RR >24 bpm, WBC >12K or <4K

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10
Q

What are the causative pathogens of non-purulent SSTIs?

A

streptococcus spp. - specifically S. pyogenes
MRSA if: penetrating trauma, evidence of MRSA elsewhere, nasal colonization with MRSA, IVDU, SIRS/severe infection, failed non-MRSA antibiotic regimen

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11
Q

What is the treatment for mild non-purulent SSTIs?

A

oral antibiotics: penicillin VK or cephalosporin or dicloxacillin (no longer used) or clindamycin

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12
Q

What is the treatment for moderate non-purulent SSTIs?

A

IV antibiotics: penicillin or ceftriaxone or cefazolin or clindamycin

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13
Q

What is the treatment for severe non-purulent SSTIs?

A

emergent surgical inspection/debridement
empiric antibiotics: vancomycin PLUS piperacillin/tazobactam –>
C&S –> narrow based on culture and sensitivity

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14
Q

What is the duration of treatment for non-purulent SSTIs?

A

5 days

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15
Q

What are the types of purulent SSTIs?

A

abscesses, furuncles, and carbuncles

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16
Q

What are the characteristics of purulent SSTIs?

A

Pus

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17
Q

What are abscesses?

A

collection of pus within the dermis and deeper skin tissues

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18
Q

What are furuncles?

A

small abscess formation of the hair follicle

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19
Q

What are carbuncles?

A

infection involving several adjacent follicles

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20
Q

What is the patient presentation of purulent SSTIs?

A

tender, red nodules, erythema, warm to touch
systemic signs of infections (systemic signs way less common in pts with furuncles)

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21
Q

What cultures should you get to diagnose purulent SSTIs?

A

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

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22
Q

What imaging should you get done in purulent SSTIs?

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A

CT/MRI to confirm presence of abscess

23
Q

What is the classification of purulent SSTIs?

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A

mild - NO systemic signs of infection
moderate - systemic signs of infection
severe - meets SIRS criteria (need to have 2 out of the 4): temp >38C or <36C, HR >90 bpm, RR >24 bpm, WBC >12K or <4K

24
Q

What are the causative pathogens of purulent SSTIs?

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A

MRSA!, MSSA, and streptococcus spp.

25
What is the treatment for mild purulent SSTIs?
I&D (incision and drainage, NO antibiotics)
26
What is the treatment for moderate purulent SSTIs?
I&D and C&S --> empiric antibiotics: TMP/SMX or doxycycline --> targeted antibiotics: for MRSA - TMP/SMX or doxycycline for MSSA: dicloxacillin or cephalexin
27
What is the treatment for severe purulent SSTIs?
I&D and C&S --> empiric antibiotics: vancomycin or daptomycin or linezolid --> targeted antibiotics: for MRSA - same as empiric for MSSA: nafcillin or cefazolin or clindamycin
28
What is the duration of treatment for purulent SSTIs?
5 days
29
What are the characteristics of necrotizing fasciitis?
medical emergency! - associated with high morbidity and mortality severe, non-purulent skin and soft tissue infection
30
What is the patient presentation of necrotizing fasciitis?
profound systemic toxicity change in color of skin to maroon/purple/black, crepitus (cracking of skin from gas buildup), edema, severe pain
31
What cultures should you get to diasnose necrotizing fasciitis?
blood cultures are recommended given severe infection wound cultures likely obtained from surgery
32
What imaging should you get done in diagnosing necrotizing fasciitis?
CT/MRI to confirm necrotizing fasciitis or presence of abscess
33
What are the causative pathogens of necrotizing fasciitis?
monomicrobial and polymicrobial streptococcus spp (most common!), vibrio vulnificus, peptostreptococcus spp, CA-MRSA, aeromonas hydrophila, clostridium perfringens
34
Treatment of necrotizing fasciitis
emergent surgical inspection/debridement empiric antibiotics: vancomycin PLUS piperacillin/tazobactam --> C&S --> targeted antibiotics: S. pyogenes - PCN PLUS clindamycin polymicrobial - vancomycin plus piperacillin/tazobactam use surgical intervention + broad spectrum antibiotics
35
What is the duration of treatment for necrotizing fasciitis?
further debridement is no longer necessary patient has improved clinically fever has been absent for 48-72 hours
36
Why clindamycin?
inhibits streptococcal toxin production inoculum effect maintains efficacy regardless of bacteria load!
37
What are other SSTIs?
impetigo and animal/human bites
38
What are the features of impetigo?
highly contagious superficial skin infection caused by skin abrasions common in children and in hot/humid weather patient presentation: small, painless, fluid filled vesicles that can lead to thick golden crusts; systemic signs of infection are rare
39
What cultures should you get to diagnose impetigo?
cultures from pus/exudates are recommended but are not required
40
What is the treatment of impetigo?
empiric coverage against: streptococcus spp and S. aureus if few lesions are present - topical x 5 days - mupirocin if many lesions are present/outbreak - oral x 7 days - dicloxacillin or cephalexin (1st line) streptococcus only: pencillin allergies/MRSA: doxycycline, clindamycin, TMP/SMX
41
What is the patient presentation for animal/human bites?
cat bites: deep, sharp puncture wound dog/human bites: cellulitis signs and symptoms
42
What cultures should you get done if you have an animal bite?
blood cultures are recommended
43
What are the causative pathogens of animal/human bites?
human bites - eikinella corrodens and streps animal bites - pasturella spp (cat bites) need to cover aerobic and anaerobic because anaerobes commonly found in the mouth
44
What is the treatment of animal/human bites?
established infection: x 7-14 days preemptive: x 3-5 days - immunocompromised, asplenia, moderate-severe bites, bites on face/hand, bites that penetrate joints DOC: amoxicillin/clavulanate alternative: 2nd/3rd generation cephalosporin + anerobic coverage beta-lactam allergy present: cipro/levofloxacin + anaerobic coverage OR moxifloxacin vaccines: Tdap if due, +/- rabies
45
What are the risk factors for diabetic foot infections?
neuropathy, angiopathy/ischemia, immunologic defects, poor wound healing
46
What is the patient presentation of diabetic foot infections?
typical local signs of infection, +/- purulent secretions more specific to DFI: discolored tissue, foul odor
47
What cultures should you get to diagnose diabetic foot infections?
wound cultures: not recommended for mild infection bone cultures: typically obtained following I&D blood cultures: may be considered (reserved for pts with severe infections)
48
What are the causative pathogens for diabetic foot infections?
all have S. aureus and streptococci spp. macerated ulcer due to soaking: also has pseudomonas aerogenes, which is a water bug!
49
What are the risk factors for MRSA in diabetic foot infections?
previous MRSA infection within past year local MRSA prevalence > 30-50% recent hospitalization failed non-MRSA antibiotics if pt is in indy, add on MRSA coverage!!
50
What are the risk factors for pseudomonas in diabetic foot infections?
history of pseudomonas infection soaking feet in water warm climate severe infection failed non-pseudomonal antibiotics
51
What is the overall management of diabetic foot infections?
surgical intervention glycemic control antibiotics
52
What is the treatment for mild diabetic foot infections?
need to cover: MSSA, streptococci spp. first line: dicloxacillin, cephalexin, clindamycin duration: 1-2 weeks recent antibiotics?: switch to - amoxicillin/clavulanate, levofloxacin, or moxifloxacin MRSA risk factors?: switch to - sulfamethoxazole/trimethoprim, or doxycycline
53
What is the treatment for moderate diabetic foot infections?
need to cover: MSSA, streptococci spp, enterobacteriaceae, anaerobes first line: moxifloxacin, amoxicillin/clavulanate, cipro/levofloxacin + clindamycin or metronidazole duration: 2-3 weeks pseudomonal risk factors?: switch to - cipro/levofloxacin + clindamycin or metronidazole MRSA risk factors?: ADD - doxycyline, linezolid, vancomycin, sulfamethoxazole/trimethoprim
54
What is the treatment for severe diabetic foot infections?
need to cover: MSSA, streptococci spp, enterobacteriaceae, anaerobes, pseduomonas first-line: piperacillin/tazobactam, carbapenem, cefepime + clindamycin or metronidazole duration: 2-3 weeks MRSA risk factors?: ADD - vancomycin, linezolid, daptomycin

PHRM 865 (61 decks)

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