MORE COMMONLY = S. AUREUS LESS COMMONLY = STREP. PYOGENES

SMALL AREAS = TOPICAL ANTIBIOTICS ALONE LARGE AREAS = TOPICAL Rx + ORAL ANTIBIOTICS e.g. FLUCLOXACILLIN

COMBINATION of ANTI-STAPHYLOCOCCAL + ANTI-STREPTOCOCCAL ANTIBIOTICS EXTENSIVE DISEASE = ADMISSION for IV ANTIBIOTICS + REST 1ST = FLUCLOXACILLIN

Skin + Soft Tissue Infections Flashcards by Annzela D'Costa

Things to consider

site, organisms, host, environment

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Impetigo presentation

SUPERFICIAL SKIN INFECTIONS
MULTIPLE VESICULAR LESIONS on ERYTHEMATOUS BASE
GOLDEN CRUST (highly suggestive of impetigo, if vesicles burst)
Usually EXPOSED PARTS of BODY incl. FACE, EXTREMITIES, SCALP

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Impetigo predisposing factors

SKIN ABRASIONS
- MINOR TRAUMA
- BURNS
- POOR HYGIENE
- INSECT BITES
- CHICKENPOX
- ECZEMA
- ATOPIC DERMATITIS

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Impetigo organisms

MORE COMMONLY = S. AUREUS

* LESS COMMONLY = STREP. PYOGENES

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Impetigo management

SMALL AREAS = TOPICAL ANTIBIOTICS ALONE

* LARGE AREAS = TOPICAL Rx + ORAL ANTIBIOTICS e.g. FLUCLOXACILLIN

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Erysipela presentation

INFECTION of UPPER DERMIS
PAINFUL RED AREA (NO CENTRAL CLEARING)
- Inflammatory process causes inflammation - stretches nn. fibres
ASS. FEVER
REGIONAL LYMPHADENOPATHY + LYMPHANGITIS
DISTINCT ELEVATED BORDERS
70 - 80% = involves LOWER LIMBS
5 - 20% = affect FACE

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Erysipela risk factors

AREAS of:

* PRE-EXISTING LYMPHOEDEMA
* VENOUS STASIS
* OBESITY
* PARAPARESIS
* DM

MAY involve INTACT SKIN - haematogenic spread to area

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Erysipela organisms

• MOST COMMONLY = STREP. PYOGENES

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Erysipela management

COMBINATION of ANTI-STAPHYLOCOCCAL + ANTI-STREPTOCOCCAL ANTIBIOTICS
EXTENSIVE DISEASE = ADMISSION for IV ANTIBIOTICS + REST
1ST = FLUCLOXACILLIN

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Cellulitis presentation

DIFFUSE SKIN INFECTION involving DEEP DERMIS + S/C FAT
SPREADING ERYTHEMATOUS AREA w/ NO DISTINCT BORDERS
FEVER is common
REGIONAL LYMPHADENOPATHY + LYMPHANGITIS
- Pt. can have LYMPHANGITIS and/or LYMPHADENITIS
GOLDEN BULLAE - RELEASE STRAW COLOURED FLUID when they BURST

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Cellulitis predisposing factors

DM
- TINEA PEDIS - ATHLETE’S FOOT
- LYMPHOEDEMA

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Folliculitis presentation

CIRCUMSCRIBED, PUSTULAR INFECTION of a HAIR FOLLICLE
≤ 5 mm in DIAMETER
SMALL RED PAPULES
CENTRAL AREA of PURULENCE that may RUPTURE + DRAIN

• CONSTITUTIONAL SYMPTOMS NOT OFTEN

Typically found on HEAD, BACK, BUTTOCKS, EXTREMITIES

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Furunculosis presentation

SINGLE HAIR FOLLICLE-ASS. INFLAMMATORY NODULE
EXTENDING into DERMIS + S/C TISSUE
Usually affects MOIST, HAIRY FRICTION-PRONE BODY AREAS - FACE, AXILLA, NECK, BUTTOCKS
May SPONTANEOUSLY DRAIN PURULENT AREA
SYSTEMIC SYMPTOMS UNCOMMON

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Carbuncle presentation

Occurs when INFECTION EXTENDS to involve MULTIPLE FURUNCLES
Often located on BACK of NECK, POSTERIOR TRUNK/THIGH
MULTI-SEPTATED ABSCESSES - v. difficult to treat
PURULENT MATERIAL may be EXPRESSED FROM MULTIPLE SITES
CONSTITUTIONAL SYMPTOMS COMMON = PT. V. UNWELL, ass. w/ BACTERAEMIA + can present w/ SEPTIC SHOCK

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Carbuncle presentation

Occurs when INFECTION EXTENDS to involve MULTIPLE FURUNCLES
Often located on BACK of NECK, POSTERIOR TRUNK/THIGH
MULTI-SEPTATED ABSCESSES - v. difficult to treat
PURULENT MATERIAL may be EXPRESSED FROM MULTIPLE SITES
CONSTITUTIONAL SYMPTOMS COMMON = PT. V. UNWELL, ass. w/ BACTERAEMIA + can present w/ SEPTIC SHOCK

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Furunculosis risk factors

OBESITY
- DM
- ATOPIC DERMATITIS
- CKD
- CORTICOSTEROID USE

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Folliculitis organisms

• FOLLICULITIS MOST COMMON = S. AUREUS

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Furunculosis organisms

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• FURUNCULOSIS MOST COMMON = S. AUREUS

Folliculitis management

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NOT Rx/TOPICAL ANTIBIOTICS

Furunculosis management

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NO Rx/TOPICAL ANTIBIOTICS - if NO IMPROVEMENT = ORAL ANTIBIOTICS may be necessary

Carbuncle management

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often req. HOSPITAL ADMISSION, SURGERY, IV ANTIBIOTICS

Necrotising fasciitis presentation

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INFECTIOUS DISEASE EMERGENCY
ANY SITE can be AFFECTED
RAPID ONSET
SEQUENTIAL DEVELEOPMENT of ERYTHEMA + EXTENSIVE OEDEMA + SEVERE UNREMITTING PAIN
HAEMORRHAGIC BULLAE, SKIN NECROSIS, CREPITUS may develop (if skin touched - may feel as if it’s creaking underneath due to air)
SYSTEMIC FEATURES incl. FEVER, HYPOTENSION, TACHYCARDIA, DELIRIUM, MULTI-ORGAN FAILURE
ANAESTHESIA at INFECTION SITE = HIGHLY SUGGESTIVE of this disease

Necrotising fasciitis presentation

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INFECTIOUS DISEASE EMERGENCY
ANY SITE can be AFFECTED
RAPID ONSET
SEQUENTIAL DEVELEOPMENT of ERYTHEMA + EXTENSIVE OEDEMA + SEVERE UNREMITTING PAIN
HAEMORRHAGIC BULLAE, SKIN NECROSIS, CREPITUS may develop
SYSTEMIC FEATURES incl. FEVER, HYPOTENSION, TACHYCARDIA, DELIRIUM, MULTI-ORGAN FAILURE
ANAESTHESIA at INFECTION SITE = HIGHLY SUGGESTIVE of this disease

Necrotising fasciitis organisms

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TYPE 1 = MIXED AEROBIC + ANAEROBIC INFECTION (DIABETIC FOOT INFECTION, FOURNIER’S GANGRENE)
- TYPICAL = STREPTOCOCCI, STAPHYLOCOCCI, ENTEROCOCCI, GRAM -VE BACILLI, CLOSTRIDIUM
TYPE 2 = MONOMICROBIAL
- Normally ass. w/ = STREP. PYOGENES

Necrotising fasciitis management

* SURGICAL REVIEW MANDATORY * IMAGING may help - could delay rx * BROAD-SPECTRUM ANTIBIOTICS = FLUCLOXACILLIN, GENTAMICIN, CLINDAMYCIN

Pyomyositis presentation

* PURULENT INFECTION DEEP w/I STRIATED MUSCLE, often manifests as ABSCESS * INFECTION OFTEN SECONDARY to SEEDING INTO DAMAGED MUSCLE (e.g. haematogenic spread) * MULTIPLE SITES involved in 15% * COMMON SITES = THIGH, CALF, ARMS, GLUTEAL REGION, CHEST WALL, PSOAS MUSCLE * FEVER, PAIN, WOODY INDURATION of AFFECTED MUSCLE * UNTREATED = SEPTIC SHOCK, DEATH

Pyomyositis predisposing factors

* DM * HIV/IMMUNOCOMPROMISED * PWID * RHEUMATOLOGICAL DISEASES * MALIGNANCY * LIVER CIRRHOSIS

Pyomyositis organisms

* COMMONEST = S. AUREUS | * OTHER = GRAM +VE, GRAM -VE, TB, FUNGI

Pyomyositis investigations

• CT/MRI

Pyomyositis management

• DRAINAGE w/ ANTIBIOTIC COVER depending on GRAM STAIN + CULTURE RESULTS

Septic bursitis presentation

* INFECTION often from ADJACENT SKIN INFECTION * PERIBURSAL CELLULITIS, SWELLING, WARMTH are COMMON * FEVER + PAIN ON MOVEMENT

Septic bursitis predisposing factors

* RHEUMATOID ARTHRITIS - deformed joints, abnormal synovium due to inflammatory process * ALCOHOLISM * DM * PWID * IMMUNOSUPPRESSION * RENAL INSUFFICIENCY

Septic bursitis organisms

* MOST COMMON = S. AUREUS | * RARE = GRAM -VE, MYCOBACTERIA, BRUCELLA (SEPTIC BURSITIS, FARMERS, RECURRENT BURSITIS)

Septic bursitis investigations

• DIAGNOSIS = based on ASPIRATION of FLUID

IV catheter ass. infection presentation

* NOSOCOMIAL INFECTION | * Normally starts as LOCAL SST INFLAMMATION (red area, swollen vein) - progresses to CELLULITIS + TISSUE NECROSIS

IV catheter ass. infection risk factors

* CONTINUOUS INFUSION > 24 HRS * CANNULA IN SITU > 72 HRS * CANNULA IN LOWER LIMB * PT. w/ NEUROLOGICAL/NEUROSURGICAL PROBLEMS

IV catheter ass. infection organisms

* MOST COMMON = S. AUREUS (MSSA + MRSA) * COMMONLY forms BIOFILM - which then SPILLS INTO BLOODSTREAM * Can SEED OTHER PLACES e.g. endocarditis, OM

IV catheter ass. infection investigations

• DIAGNOSIS = made CLINICALLY/+VE BLOOD CULTURES

IV catheter ass. infection management

* REMOVE CANNULA * EXPRESS ANY PUS from THROMBOPHLEBITIS * IV ANTIBIOTICS for AT LEAST 14 DAYS * ECHO PREVENTION MORE IMPORTANT: * DO NOT LEAVE UNUSED CANNULA * DO NOT INSERT CANNULA UNLESS THEY WILL BE USED * CHANGE CANNULAS EVERY 72HRS * MONITOR for THROMBOPHLEBITIS * USE ASEPTIC TECHNIQUE when INSERTING CANNULAE

Surgical site infection presentation

* CLASS 1 = CLEAN WOUND (RESPIRATORY, ALIMENTARY, GENITAL, INFECTED URINARY SYSTEMS NOT ENTERED) * CLASS 2 = CLEAN-CONTAMINATED WOUND (ABOVE TRACTS ENTERED, BUT NO UNUSUAL CONTAMINATION) * CLASS 3 = CONTAMINATED WOUND (OPEN, FRESH ACCIDENTAL WOUNDS/GROSS SPILLAGE from GIT e.g. ruptured appendix, peritonitis) * CLASS 4 = INFECTED WOUND (EXISTING CLINICAL INFECTION, INFECTION PRESENT BEFORE OPERATION)

Surgical site infection organisms

* S. AUREUS * COAGULASE -VE STAPHYLOCOCCI * ENTEROCOCCUS * E. COLI * PSEUDOMONAS AERUGINOSA * ENTEROBACTER * STREPTOCOCCI * FUNGI * ANAEROBES

Surgical site infection investigations

DIAGNOSIS: * SEND PUS/INFECTED TISSUE for CULTURES esp. w/ CLEAN WOUND INFECTIONS * AVOID SUPERFICIAL SWABS - AIM for DEEP STRUCTURES * CONSIDER UNLIKELY PATHOGEN as CAUSATIVE IF OBTAINED from STERILE SITE e.g. bone infection

Surgical site infection management

• ANTIBIOTICS to TARGET LIKELY ORGANISMS

Skin + Soft Tissue Infections Flashcards

(43 cards)