SSTI

Question 1

what cells contribute to the innate immune system

Answer 1

keratinocytes and langerhan cells (epidermis)

Question 2

what are the three main bacteria living on the skin?

Answer 2

staphylococcus
corynebacterium
propionibacterium ( most common, gram positive )

Question 3

are cultures useful in non purulent infections?

Answer 3

no

Question 4

what should patients with purulent infections get?

Answer 4

incisions & drainage + cultures

Question 5

what should patients with systemic signs of infections receive

Answer 5

parenteral antibiotics at least until clinical improvements

Question 6

SIRS

Answer 6

febrile (>100.4 )
hypothermic (<96.8)
RR >24 breath/min
leukocytosis
leukopenic

Question 7

what are the 3 tenants of infectious diseases

Answer 7

source control x3

Question 8

Impetigo causative organism

Answer 8

Group A streptococcus

Question 9

Impetigo Treatment nonpharm

Answer 9

local wound care

Question 10

Impetigo treatment
mild, low risk of transmission

Answer 10

topical abx
mupirocin or retapamulin BID

Question 11

Impetigo
mild, multiple

Answer 11

PO abx with GAS and/or MSSA coverage

Penicillin
Amoxicillin-clav
cephalexin
clindamycin
dicloxacillin

Question 12

Impetigo treatment
expensive lesions and /or failed initial therapy

Answer 12

consider PO MRSA coverage

SMX/TMP
Doxycycline
Linezolid

Question 13

duration of therapy for Impetigo

Answer 13

5-7 days ( 5 for mild and 7 for more extensive disease)

Question 14

impetigo is non purulent or purulent

Answer 14

non purulent

Question 15

ecthyma causative organisms

Answer 15

Group A strept
MSSA/MSRA

Question 16

Ecthyma treatment
mild

Answer 16

PO abx with GAS and/ or MSSA

Penicillin
Amoxicillin-clav
cephalexin
clindamycin
dicloxacillin

Question 17

Ecthyma treatment
extensive lesions and/or failed

Answer 17

consider PO MRSA coverage

SMX/TMP
Doxycycline
Linezolid

Question 18

Erysipelas/cellulitis causative organisms

Answer 18

pain, erythema/redness, warmth, swelling–> fever/chills, malaise, lymphangitis

Group A street
MRSA/MSSA
Group G, C

Question 19

Erysipelas/cellulitis treatment
without systemic symptom of infections

Answer 19

streptococcus coverage

Penicillin
nafcillin/oxacillin
cephalexin
cefazolin
clindamycin

Question 20

Erysipelas/cellulitis treatment
cellulitis with MRSA risk factors or critically ill

Answer 20

strep + MRSA coverage

Vanco
Linazolid
Daptomycin
ceftaroline
Clindamycin

Question 21

what is the duration of ecthyma treatment

Answer 21

7 days

Question 22

what is the duration for Erysipelas/cellulitis treatment with mild disease & hemodynamic stability treated PO

Answer 22

5 days but can be extended

Question 23

ecthyma is non purulent or purulent

Answer 23

non purulent

Question 24

erysipelas/ cellulitis is non purulent or purulent

Answer 24

non purulent

Question 25

folliculitis is non purulent or purulent

Answer 25

purulent

Question 26

folliculitis clinical manifestation and causative organisms

Answer 26

small pustule + are surrounding desquamation skin flora including gram positives and fungi ( candid and malassezia) related to contaminated water : aeromana, pseudonyms

Question 27

how does folliculitis usually resolve

Answer 27

on its ow ( regression) or with drainage

Question 28

folliculitis treatment non-severe

Answer 28

topical anti infectives +/- saline compresses mupirocin or ratapamulin BID topical anti fungal

Question 29

folliculitis treatment severe

Answer 29

empiric therapy should cover pseudomonas cefepime piper/tazo meropenem

Question 30

folliculitis treatment duration

Answer 30

5-7 days ( 5 for mild and 7 for more extensive disease)

Question 31

furuncles is non purulent or purulent

Answer 31

purulent

Question 32

furuncles clinical manifestation and causative organisms

Answer 32

painful nodules --> spontaneously drains pus s.aureus sometimes CONS

Question 33

carbuncles clinical manifestation and causative organism

Answer 33

several furuncles/ follicles larger, deeper, indurated prices fever, leukocytosis , malaise s.aureus sometimes CONS

Question 34

Furuncle/Carbuncle/ abscess Treatment non pharm

Answer 34

insision and drainage cultures should be drawn from the I&D and used tor streamline therapy

Question 35

Furuncle/Carbuncle/ abscess Treatment no systemic signs of infection

Answer 35

I&D +/- short course of PO abx that covers MRSA doxy smx/tmp linezolid clindamycin

Question 36

Furuncle/Carbuncle/ abscess Treatment systemic signs od infection, immunocompromised or failure of initial therapy

Answer 36

I&D + empiric MRSA coverage vancomycin linezolid daptomycin ceftaroline clindamycin

Question 37

what is the duration of treatment for Furuncle/Carbuncle/ abscess

Answer 37

7-14 days from I & D ( 7days for milder disease)

Question 38

pyomyositis is non purulent or purulent

Answer 38

purulent

Question 39

pyomyositis clinical mamifestation and causative organism

Answer 39

infection of the skeletal muscle painful, firm lump under the skin likely mobility issues in affected muscles s.aureus sometimes CONS

Question 40

pyomyositis non pharm

Answer 40

insision and drainage cultures should be drawn from the I&D and used tor streamline therapy

Question 41

pyomyositis treatment empiric

Answer 41

parental MRSA coverage vancomycin linezolid daptomycin ceftaroline clindamycin

Question 43

pyomyositis treatment immunocompromise, penetrating trauma to area

Answer 43

MRSA coverage + broad gram neg vancomycin linezolid daptomycin ceftaroline clindamycin cefttriaxone cefepime piper/tazo

Question 44

pyomyositis treatment duration

Answer 44

14-21 days from I & D

Question 45

necrotizing fasciitis is non purulent or purulent

Answer 45

inon purulent

Question 46

necrotizing fasciitis clinical manifestations and causative organisms

Answer 46

deep infection, can cause ischemic damage ad immune shock surgical emergency pain out of porportion**, crepitus ( gas forming organism) ** causative organism: depends :)

Question 47

NF Type 1 (poly)

Answer 47

gram neg, anarobes, and skin flora

Question 48

NF Type II (mono)

Answer 48

s.pyogenes or s.aureus ( typically MRSA)

Question 49

NF Type III

Answer 49

Clostridium vibrio aeromonas

Question 50

necrotizing fasciitis nonpharm

Answer 50

immediate trip to OR + incision and drainage culture should be drawn from OR

Question 51

necrotizing fasciitis treatment empiric ( all types)

Answer 51

broad parenteral abx to cover GN, MRSA, and anaerobes vancomycin or linezolid plus piper/ tazo or cefepie +metronidazole

Question 52

necrotizing fasciitis treatment Type II (s.pyogenes)

Answer 52

anti streptococcal drug of choice + antitoxin penicillin + clindamycin

Question 53

necrotizing fasciitis treatment Type II (s. aureus)

Answer 53

anti streptococcal drug of choice MSSA: naficillin or oxacillin or cefazolin MRSA: vancomycin or linezolid

Question 54

necrotizing fasciitis treatment Type III clostridium

Answer 54

penicillin + clindamycin

Question 55

necrotizing fasciitis treatment Type III vibrio spp Aeromanas spp

Answer 55

doxy+ ceftriaxone +ciprofloxacin

Question 56

diabetic foot

Answer 56

ulcer on the foot that maybe associated w erthma, warmth, swelling, or purulence s.aureus gram neg ( including Pseudomonas )

Question 57

diabetic foot treatment non pharm

Answer 57

do not get superficial wound cultures if deeper sample are available, they must be used to guide treatment

Question 58

diabetic foot treatment clinically uninfected

Answer 58

wound care, no abx non

Question 59

diabetic foot treatment mild - moderate infection

Answer 59

local wound care + abx the covers GP Penicillin nafcillin/ oxacillin cephalexin cefazolin clindamycin vancomycin linezolid

Question 60

diabetic foot treatment severe infections or concerns for MDRO

Answer 60

local wound care +abx that coves MRSA & pseudomonas vancomycin or linezolid plus piper/ tazo or cefepime

Question 61

animal/human bites causative organism

Answer 61

pasturella Amox-clav

Question 61

cat scratch disease

Answer 61

bartonella spp azithromycin