SSTI

Question 1

What are the systemic symptoms criteria for SSTI?

Answer 1

Temperature>38or<36
Heartrate>90bpm,
Respiratoryrate>24bpm
WBC>12x10^9/Lor<4x10^9/L

Question 2

What are the criteria for DFI and Pressure Ulcer

Answer 2

Purulent discharge

OR

≥ 2 signs & symptoms of inflammation: erythema, warmth, tenderness,
pain, induration (thickening and hardening of soft tissues of the body, specifically the skin)

Question 3

Tx duration for impetigo/ ecthyma PO antibiotics

Answer 3

7 days

Question 4

Tx for Impetigo, mild limited lesions

Answer 4

Topical Mupirocin BID x 5 days

Question 5

Impetigo/ ecthyma: Empiric (no allergy)

Answer 5

Cloxacillin or cephalexin

Question 6

Impetigo/ ecthyma: Empiric (penicillin allergy)

Answer 6

Clindamycin

Question 7

Impetigo/ ecthyma: S. pyogenes

Answer 7

PO penicillin V, amoxicillin

Question 8

Impetigo/ ecthyma: MSSA

Answer 8

PO Cloxacillin or cephalexin

Question 9

Mainstay for purulent infection (furuncle, carbuncle, skin abscess, cellulitis)

Answer 9

Incision & drainage

Question 10

When to do culture (from wound) for SSTI?

Answer 10

Wound with pus, exudate or tissues

Question 11

When to do blood culture for SSTI?

Answer 11

severe cases with marked systemic symptoms of infection or immunocompromised patients

Question 12

Tx for Mild, purulent infection (furuncle, carbuncle, skin abscess, cellulitis)

Answer 12

I&D or warm compress to promote drainage

Question 13

Tx for moderate (with systemic sx), purulent infection (furuncle, carbuncle, skin abscess, cellulitis)

Answer 13

I & D PLUS
PO cloxacillin/ cephalexin / clindamycin (if allergy)

Question 14

Tx for Severe, purulent infection (furuncle, carbuncle, skin abscess, cellulitis)

Answer 14

I & D PLUS
IV cloxacillin/ cefazolin/ clindamycin (penicillin allergy), vancomycin (last line)

Question 15

Empiric MRSA for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)

Answer 15

Cotrimoxazole, doxycycline, clindamycin, vancomycin, daptomycin, linezolid

Question 16

Empiric (gram‐neg, anaerobe) for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)

Answer 16

Augmentin

Question 17

Tx duration for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)

Answer 17

5-10d

Question 18

Likely pathogen for impetigo

Answer 18

Staphlococci or streptococci

Question 19

Bullous form of impetigo is caused by ____

Answer 19

Toxin-producing strains of S. aureus

Question 20

Likely pathogen for nonpurulent (cellulitis, erysipelas)

Answer 20

S. pyogenes, less frequently S. aureus, water exposure (Aeromonas, Vibrio vulnificus, Psuedomonas)

Question 21

Likely pathogen for purulent (furuncle, carbuncle, skin abscess, cellulitis)

Answer 21

Mainly S. aureus, some streptococci, skin abscess (gram negs & anaerobes), CA-MRSA (More for US)

Question 22

Treatment for mild (no systemic signs), nonpurulent (cellulitis, erysipelas)

Answer 22

PO Penicillin V (if no need MSSA cover)/ cloxacillin/ cephalexin/ clindamycin (if allergy)

Question 23

Treatment for moderate (systemic signs, some purulence), nonpurulent (cellulitis, erysipelas)

Answer 23

IV cefazolin/ clindamycin (penicillin allergy)

Question 24

Treatment for severe (systemic signs, failed oral therapy, immunocompromised), nonpurulent (cellulitis, erysipelas)

Answer 24

IV: pip-tazo/ cefepime/ meropenem
If MRSA risk factor, add IV vancomycin, daptomycin, linezolid
x 5-10d; 14 days if immunocompromised

Question 25

Non-pharm for non-purulent

Answer 25

- Ensure rest and limb elevation (drainage of edema and inflammatory - Treat underlying conditions eg tinea pedis, skin dryness, limb edema substances)

Question 26

Monitoring for SSTI

Answer 26

1) Should get better within 2-3 days; Else, assess indication and/or choice of antibiotics 2) Check that there is no progression of lesion or development of complication 3) Switch to oral antibiotic when pt is better 4) Repeat culture not needed for those who responded 5) Absence of ADR & allergies

Question 27

Definition for mild DFI

Answer 27

Infection of skin and SC tissue + If erythema: ≤ 2 cm around ulcer + No signs of systemic infection

Question 28

Organisms to cover for mild DFI

Answer 28

Staph aureus & streptococci

Question 29

Definition for moderate DFI

Answer 29

Infection of deeper tissue (e.g. bone, joints); or If erythema: > 2 cm + No signs of systemic infx

Question 30

Definition of severe DFI

Answer 30

Infection of deeper tissue (e.g. bone, joints); or If erythema: > 2 cm + Sign(s) of systemic infx

Question 31

Organisms to cover for moderate DFI

Answer 31

Staph aureus + streptococci + anaerobes + gram negs (+/- pseudomonas)

Question 32

Organisms to cover for severe DFI

Answer 32

Staph aureus + streptococci + anaerobes + gram negs (including pseudomonas)

Question 33

PO antibiotics for mild DFI

Answer 33

PO cloxacillin/ cephalexin/ clindamycin (penicillin allergy) -> MRSA cover: PO co-trimoxazole/ clindamycin/ doxycycline

Question 34

IV antibiotics for moderate DFI

Answer 34

IV Augmentin OR cefazolin/ ceftriaxone + metronidazole -> MRSA cover: IV vancomycin/ linezolid/ daptomycin

Question 35

IV antibiotics for severe DFI

Answer 35

IV pip-tazo OR Cefepime + metronidazole OR Meropenem OR ciprofloxacin + clindamycin -> MRSA cover: IV vancomycin/ linezolid/ daptomycin

Question 36

Duration of tx for mild DFI, no bone involvement

Answer 36

1-2 weeks

Question 37

Duration of tx for moderate DFI, no bone involvement

Answer 37

1-3 weeks

Question 38

Duration of tx for severe DFI, no bone involvement

Answer 38

2-4 weeks

Question 39

Duration of tx for Surgery – all infected bone and tissue removed (e.g. amputation)

Answer 39

2-5 days

Question 40

Duration of tx for Surgery - Residual infected soft tissue

Answer 40

1-3 weeks

Question 41

Duration of tx for Surgery – Residual viable bone

Answer 41

4-6 weeks

Question 42

Duration of tx for No surgery or Surgery – residual dead bone

Answer 42

≥ 3 months

Question 43

Non-pharm for pressure ulcers

Answer 43

- Debridement of infected or necrotic tissue – Local wound care (Avoid harsh chemicals; normal saline preferred) – Relief of pressure (Turn or reposition every 2 hours)

Question 44

4 factors contributing to pressure ulcers

Answer 44

- Pressure (amount and duration) – Shearing force – Moisture – Friction

Question 45

Non-pharm for DFI

Answer 45

- Wound care (debridement, off loading, apply dressings that promote a healing environment & control excess exudate) - Foot care (daily inspection & prevent wound and ulcers) - Optimal glycemic control