Skin & Soft Tissue Infections Flashcards
(40 cards)
What is the empiric antimicrobial therapy for moderate purulent (furuncle, carbuncle, abscess) infection?
Cephalexin (unless high MRSA prevalence) OR
TMP/SMX OR
Doxycycline
What is the empiric treatment for severe purulent (furuncle, carbuncle or abscess) infection?
Vancomycin
What is the empiric therapy for mild cellulitis, without signs of systemic infection or purulence?
Oral cephalexin x 5 days - can extend if no improvement at completion.
What did the PATCH I trial show?
Patients with at least 2 episodes of cellulitis over the past 3 years were treated prophylactically with oral amoxicillin or cephalexin daily for at least 1 year. This was found to be effective in preventing subsequent attacks while on prophylaxis.
What do the guidelines suggest for cellulitis prophylaxis?
Consider if > or = 3 episodes of cellulitis per year DESPITE controlling other risk factors, such as re-vascularization, wound care, footwear, compression, treated tinea.
What is the role of compression stockings in recurrent cellulitis?
Compression therapy results in lower incidence of recurrent cellulitis.
What is the empiric therapy for suspected necrotizing fasciitis?
Piptazo 3.375 g IV Q6H +
Vancomycin 15-20 mg/kg IV Q12H + Clindamycin 600 mg IV Q8H
How do you treat necrotizing fasciitis secondary to Group A Strep?
Penicillin/Beta-Lactam +
Clindamycin
What are the criteria for streptococcal toxic shock syndrome?
- Hypotension (sBP < 90 mmHg) AND
- Isolation of GAS from a normally sterile site AND
2 of the following:
- Renal Impairment (Cr> 177)
- Coagulopathy (Plt < 100 or DIC)
- Liver Fxn Abnormality (AST/ALT/Tbili 2 x ULN)
- ARDS
- Generalized erythematous macular rash that may desquamate
What precautions due toxic shock syndrome require?
Contact & Droplet
Which microorganism is responsible for green nail syndrome?
Pseudomonas aeruginosa
Which organism should you cover for with malignant otitis externa?
Pseudomonas aeruginosa
Which microorganism is responsible for oral hairy leukoplakia?
EBV
What are the characterisitics of a neuropathic foot ulcer?
- Pressure point ulcers
- Punched out appearance
- Deep ulcer
- Minimal pain
- Warm and dry foot
What are the characterisitics of an arterial foot ulcer?
- Lateral malleolus
- Dry & punctate
- Decreased pulses
- Cold & dry foot
What are the characterisitics of venous foot ulcers?
- Medial malleolus
- Irregular margins
- Shallow depth
- Mildly painful
- Venous stasis dermatitis/lipodermatosclerosis
What has the highest likelihood ratio for an infected foot ulcer?
Pain in a chronic wound (+ LR 11-20)
What is the gold standard for diagnosis of osteomyelitis?
Bone biopsy and culture
What clinical findings has the highest likelihood ratio for osteomyelitis?
ESR > 70 has a + LR of 11
Bone exposure has a + LR of 9.2
Which clinical finding has the best negative likelihood ratio for osteomyelitis?
Negative MRI has a negative LR of 0.14
What is the most common causative organism in native vertebral osteomyelitis?
S. Aureus
If you suspect vertebral OM, what workup is guideline recommended?
- Blood cultures (2 sets)
- Baseline ESR/CRP
- MRI Spine
What is the recommended management of vertebral osteomyelitis?
- Hold abx until biopsy if no sepsis/neurological compromise
- Then start empiric ceftriaxone and vancomycin
- Continue abx for 6 weeks
- Repeat inflammatory markers at 4 week
- Repeat MRI ONLY if poor clinical response
What is the empiric antibiotics for prosthetic joint infection?
Vancomycin and CTX
Antibiotics for 4-6 weeks IV or high dose oral with consideration for chronic suppression w/daily oral abx thereafter
