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Therapeutics IV > Soft Skin Infection - Block 1 > Flashcards

Soft Skin Infection - Block 1 Flashcards

1
Q

List bacteria that is normal found on skin?

A
  1. S. aueus
  2. S. epidermis
  3. S. pyogenes
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2
Q

Superficial skin infection with fluid filled vesicles?

A

Impetigo

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3
Q

Superficial skin infection with extensive lymphatic involvement?

A

Erysipelas

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4
Q

Infection of dermis, epidermis, and superficial fascia with poorly defined margins?

A

Cellulitis

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5
Q

Inflammation of the hair follicules of the dermis and subcutaneous laye?

A

Furuncles

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6
Q

Infllamation of the hair follicles of the subcutaneous or deeper tissue

A

Carbuncles

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7
Q

Progessive destruction of superficial fascia and SQ fat?

A

Necrotizing fascitis

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8
Q

Consisitng or containing pus

A

Purulent

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9
Q

Describe the causes of purulent infections?

A
  1. b-hemolytic Strep
  2. Cellulitis
  3. Abscesses caused by MRSA
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10
Q

Cause of impetigo?

A

staph. aureus, GAS

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11
Q

Cause of erysipleas?

A

Group A strep

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12
Q

Cause of cellulitis?

A

Group A strep, S. aureus

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13
Q

Cause of necrotizing fascitis II?

A

Monomicribial: group A strep, clostidium perfrigens

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14
Q

Cause of necrotizing fascitis?

A

Polymicrobia: aerobes, anaerobes, facultative bacteria

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15
Q

Cause of diabetic foot infection?

A

Polymicrobial: s. aureus, strep, enterobac, bacteriodes, P. aeriginosa

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16
Q

Cause of bite wound infection?

A

Aerobes and anaerobes

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17
Q
A
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18
Q

What is the difference between primary and secondary infection?

A

Primary: healthy skin
Secondary: progressive infection from already damaged skin

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19
Q

What is a complicated infection?

A
  1. Deeper layer and/or DM, HIV, immune deficiency
  2. CA-SSTI (S. aureus)
  3. HA-SSTI (MRSA)
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20
Q

Infectious agents of purulent infections?

A

Both S. aureus and Group A strep

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21
Q

Infectious agents of erysipelas?

A

B-hemolytic strep

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22
Q

Infectious agent of impetigo and cellulitis?

A

MSSA +/- b-hemolytic strep

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23
Q

Immunocompromised patients are more likely to aquire infections from ___?

A

Fungi

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24
Q

Cellulitis from bites are more likely to be a mix of ___?

A

Aerobes and anaerobes

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25
Q

What are polymicrobial infections?

A

Both G- and + that have synergistic effects

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26
Q

Bacterial strains most common in surgical site infections?

A

G- and anaerobes

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27
Q

What are the presentations of impetigo?

A

Bullous: painless, fluid-filled blisters on face, arms, and legs
Nonbullous: clusters of vesciles or pustules, ooze fluid forming honey-colored scabs

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28
Q

Presentations of erysipelas?

A

Painful, redness, swollen with high WBC and temp

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29
Q

How are the presentations of erysipelas and cellulitis caused by its underlying microbia?

A

GAS: hemolysis
Lymphatic system: pain

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30
Q

Presentation of cellulitis?

A

Systemic presentation -> severe

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31
Q

What is an abscess?

A

Collection of pus within the dermis or subcutaneous space

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32
Q

Presentations of furuncles?

A

Painful, firm pustules along hair follicles

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33
Q

Presentations of carbuncles?

A

A deep-seated purulent infection that forms sinus tracts between hair follicles

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34
Q

What is the difference between necrotizing fasciitis type 1 and 2?

A

Type 1: secondary to diabetic patients or other comorbities
Type 2: Primary to strep

35
Q

Biomarkers of SSRIs?

A
  1. > 38 C
  2. Tachycardia (>90bpm)
  3. Tachypnea (>24bpm)
  4. WBC (>12000)
36
Q

List nonspecific markers of infection?

A

CRP, ESR

37
Q

Diagnostic tools for SSTI?

A
  1. Tissue culture (Not for non-severe infections)
  2. Blood culture (Systemic infection)
  3. Ultrasonography (Abscesses)
  4. CT/MRI (Deep seated infection)
38
Q

Nonpharm for SSTI?

A
  1. Incision and drainage
  2. Warm compress
  3. Debridement
  4. Raise leg
  5. Irrigation of bite wounds with NS
39
Q

RF for MRSA?

A
  1. Hx of MRSA
  2. Recent hospitalizaation
  3. IVDU
  4. Immunocompromised
  5. Prevalence of MRSA ≥30%
  6. Penetrating trauma
  7. Treatment failure or severe infection
40
Q

How do we prevent MRSA transmission?

A
  1. Careful hand hygiene
  2. Keep wounds lightly covered
  3. DOn’t pick sores
  4. Bleach linens
  5. Avoid sharing personal items
  6. MRSA decolonization
41
Q

Methods of MRSA decolonization?

A
  1. Nasal with mupirocin in each nostrils BID for 5 days
  2. Whole body with chlorhexidine for 5 days
42
Q

Describe severity of SSTI?

A

Mild: no systemic infection, well controlled, no comorbidities
Moderate: systemic signs, infection sx, poorly controlled comorbidites
Severe: SIRS with toxic appearance, altered mentation, hypotension, end organ dysfunction

43
Q

How do you treat mild impetigo?

A

Topical mupirocin or retapamilin ointment for 5 days

44
Q

Tx for severe the impetigo with MSSA?

A

Tx for 7 days:
1. Dicloxacillin
2. 1st gen cephalosporin
3. Penicillin G or VK

45
Q

Tx for severe the impetigo with MRSA?

A

Tx for 7 days:
1. Clindamycin
2. Doxycycline
3. Bactrim
4. Vancomycin (very severe)

46
Q

Tx for mild-moderate erysipelas?

A

Outpatient for 7-10 days:
* Penicillin VK (PO)
* Pen allergy: Clindamycin

47
Q

Tx for severe erysipelas?

A

7-10 day course: Penicillin G IV -> if sx improve transition to PO

48
Q

How should you evaluate erysipelas tx?

A
  • Temp and WBC to normal within 48-72H
  • Erythema, edema, and pain resolves gradually (may worsen 72H its is a sign of course of infection not tx failure)
49
Q

Types of nonpurulent SSTIs?

A
  1. Nonpulent cellulitis
  2. Necrotizing fasciitis
50
Q

Types of purulent SSTIs?

A
  1. Nonpurulent cellulitis
  2. Furuncle, carbuncle
  3. Abscess
51
Q

Tx for Mild, non-MRSA Nonpurulent cellulitis?

A

PO coverage for strep for 5 days:
1. Penicillin VK
1. Cephalexin
1. Dicloxacillin
1. Clindamycin

52
Q

Tx for Mild, MRSA Nonpurulent cellulitis?

A

PO coverage for Strep and MRSA for 5 days:
1. Bactrim
2. Doxycycline
PLUS
Penicillin, Amoxicillin, or Cephalexin

53
Q

Tx for Moderate, non-MRSA Nonpurulent cellulitis?

A

IV for strep for 5 days:
* Penicillin
* Cefazolin
* Cefatriaxone
* Clindamycin

54
Q

Tx for Moderate, MRSA Nonpurulent cellulitis?

A

IV for MRSA and strep for 5 days:
* Vancomycin
* Daptomycin
* Linezolid
* Telavancin
* Ceftaroline

55
Q

Tx for Severe, non-necrotic Nonpurulent cellulitis?

A

Treatment for 5 days:
Vancomycin
PLUS
Zosyn, Imipenum/cilastatin, or meropenum

56
Q

Tx for Severe, necrotic Nonpurulent cellulitis?

A

Tx for th 1-2 weeks:
Vancomycin or linezolid
PLUS
Zosyn, imipenem/cilastatin, meropenum, ertapenem, or ceftriazone+metronidazole

57
Q

Tx for mild purulent cellulitis?

A

Treatment for 5 days:
* Incision and drainage of abscesses w/o ABX

58
Q

Tx for moderate purulent cellulitis?

A

Treatment for 5 days:
* Incision and drainage
AND PO MRSA coverage
* Bactrim or Doxycycline

59
Q

Tx for severe purulent cellulitis?

A

Treatment for 5 days:
* Incision and drainage
AND IV MRSA coverage
* Vancomycin, Daptomycin, Linezolid, Telavancin, or Ceftaroline

60
Q

Tx for folliculitis and mid furuncle?

A

None: warm saline compress

61
Q

Tx for furuncle and carbuncles?

A

Incision and drainage plus ABX for 5-7 days:
* Bactrim OR
* Doxycycline or Minocycline

62
Q

Nonpharm for necrotizing fasciitis?

A

Immediate debridement (>14 hrs after diagnosis can increase mortality)

63
Q

Type 1 NF treatment?

A

Empirical treatment (polymicrobial): Zosyn and Vancomycin

64
Q

Type 2 NF treatment?

A

Monomicrobial: Clindamycin + penicillin until clinically stable for 48-72 hrs -> then penicillin only

65
Q

S/s of infected DMF?

A

Local infection of:
* Swelling
* Erythema
* Local tenderness
* Pain
* Warmth purulent discharge

66
Q

S/s of mild DMF?

A
  • Local infection without deepre tissues or SIRS
  • ≥0.5 and ≤2 cm around ulcer
67
Q

S/s of moderate DMF?

A
  • Local lesion with erythema >2 cm around ulcer or deep tissue
  • NO SIRS
68
Q

Bacterial isolates in DMF?

A
  1. Aerobes
  2. Anaerobes
  3. G+ > G-
69
Q

S/s of severe DMF?

A

Local infection with 2 SIRs criteria:
* Temp >100.4F or <98.6F
* HR >90
* RR >20
* WBC >12000, <4000, or 10% bands

70
Q

P. aeruginosa RF?

A
  1. Soaking feet
  2. Discolored bumps with foul smelling drainage
  3. Failed nonpseudomonal ABX regimen
  4. Severe infection

`

71
Q

Tx for mild, non-MRSA RF DFI?

A

PO or topical (superficial) for 1-2 weeks, max 4 weeks:
Previous ABX: GPC and GNR (Levofloxacin, Moxifloxacin, Augmentin)
No previous ABX: GPC (Dicloxacillin, Clindamycin, Cephalexin

72
Q

Tx for mild, MRSA RF DFI?

A

MRSA coverage:
* Bactrim
* Doxycycline

73
Q

Tx for moderate DFI with no extensive wound or P. aeruginosa RF?

A

PO coverage for GPC, GNR, +/- obligate anaerobes for 1-3 weeks:
* Levofloxacin +/- clindamycin
* Ciprofloxacin +/- clindamycin
* Moxifloxacin
* Augmentin

with MRSA RF:
* Add doxycycline or linezolid or consider switching to IV

74
Q

Tx for moderate DFI with no extensive wound BUT with P. aeruginosa RF?

A

PO coverage for GPC, GNR, +/- obligate anaerobes for 1-3 weeks:
* Levofloxacin +/- clindamycin
* Ciprofloxacin +/- clindamycin

with MRSA RF:
* Add doxycycline or linezolid or consider switching to IV

75
Q

Tx for moderate DFI with extensive wounds and P. aeruginosa RF?

A

PO coverage for GPC, GNR, +/- obligate anaerobes for 1-3 weeks:
* Zosyn
* Ceftazime, cefepime, aztreonam, levofloxacin, ciprofloxacin with clindamycin

with MRSA RF:
* Add vancomycin, linezolid, or daptomycin

76
Q

Tx for moderate DFI with extensive wounds BUT no P. aeruginosa RF?

A

PO coverage for GPC, GNR, +/- obligate anaerobes for 1-3 weeks:
* Levofloxacin +/- clindamycin
* Ciprofloxacin + clindamycin
* Moxifloxacin
* Ceftriaxone
* Cefoxitin
* Ampicillin-sulbactam
* Ertapenum
* Tigacycline

with MRSA RF:
* Add vancomycin, linezolid, or daptomycin

77
Q

Tx for severe DFI with MRSA?

A

IV coverage for MSSA, strep, GNR, P. auruginosa, obligate anareobes and MRSA for 2-4 weeks:
Vancomycin with:
* Zosyn
* Imipenem-cilastatin
* Ceftazidime + clindamycin or metronidazole
* Cefepime + clindamycin or metronidazole
* Aztreonam + clindamycin or metronidazole

78
Q

Duration of mild-moderate DFI therapy?

A

PO: 1-2 weeks

79
Q

Duration of moderate-severe DFI therapy?

A

IV: 1-3 weeks

80
Q

Non pharm for bite wounds?

A
  1. Irrigate with SW/NS and soap/povidone-iodine
  2. Surgical debridement
  3. Elevate area to reduce edema
81
Q

When do you initiate bite wound prophylaxis?

A

All patients with human bite injuries early within 8 hours: prophylactic antibiotic therapy for 3-5 days

82
Q

Animal bite prophylaxis?

A
  1. Wound care is sufficient <12H
  2. Prophylaxis ABX (3-5 days)
  3. Tdap and rabies vaccine

`

83
Q

Pharm tx for bites?

A
  1. Augmentin
  2. Doxycycline
  3. Moxifloxacin
84
Q

When do you monitor bites?

A

Follow-up in 48-72 hours after initiating antibiotic therapy -> normal improvement in 3 days

Therapeutics IV (39 decks)

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