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SSTI Flashcards

1
Q

what cells contribute to the innate immune system

A

keratinocytes and langerhan cells (epidermis)

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2
Q

what are the three main bacteria living on the skin?

A

staphylococcus
corynebacterium
propionibacterium ( most common, gram positive )

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3
Q

are cultures useful in non purulent infections?

A

no

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4
Q

what should patients with purulent infections get?

A

incisions & drainage + cultures

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5
Q

what should patients with systemic signs of infections receive

A

parenteral antibiotics at least until clinical improvements

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6
Q

SIRS

A

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

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7
Q

what are the 3 tenants of infectious diseases

A

source control x3

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8
Q

Impetigo causative organism

A

Group A streptococcus

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9
Q

Impetigo Treatment nonpharm

A

local wound care

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10
Q

Impetigo treatment
mild, low risk of transmission

A

topical abx
mupirocin or retapamulin BID

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11
Q

Impetigo
mild, multiple

A

PO abx with GAS and/or MSSA coverage

Penicillin
Amoxicillin-clav
cephalexin
clindamycin
dicloxacillin

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12
Q

Impetigo treatment
expensive lesions and /or failed initial therapy

A

consider PO MRSA coverage

SMX/TMP
Doxycycline
Linezolid

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13
Q

duration of therapy for Impetigo

A

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

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14
Q

impetigo is non purulent or purulent

A

non purulent

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15
Q

ecthyma causative organisms

A

Group A strept
MSSA/MSRA

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16
Q

Ecthyma treatment
mild

A

PO abx with GAS and/ or MSSA

Penicillin
Amoxicillin-clav
cephalexin
clindamycin
dicloxacillin

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17
Q

Ecthyma treatment
extensive lesions and/or failed

A

consider PO MRSA coverage

SMX/TMP
Doxycycline
Linezolid

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18
Q

Erysipelas/cellulitis causative organisms

A

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

Group A street
MRSA/MSSA
Group G, C

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19
Q

Erysipelas/cellulitis treatment
without systemic symptom of infections

A

streptococcus coverage

Penicillin
nafcillin/oxacillin
cephalexin
cefazolin
clindamycin

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20
Q

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

A

strep + MRSA coverage

Vanco
Linazolid
Daptomycin
ceftaroline
Clindamycin

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21
Q

what is the duration of ecthyma treatment

A

7 days

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22
Q

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

A

5 days but can be extended

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23
Q

ecthyma is non purulent or purulent

A

non purulent

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24
Q

erysipelas/ cellulitis is non purulent or purulent

A

non purulent

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25
Q

folliculitis is non purulent or purulent

A

purulent

26
Q

folliculitis clinical manifestation and causative organisms

A

small pustule + are surrounding desquamation

skin flora including gram positives and fungi ( candid and malassezia)

related to contaminated water : aeromana, pseudonyms

27
Q

how does folliculitis usually resolve

A

on its ow ( regression) or with drainage

28
Q

folliculitis treatment
non-severe

A

topical anti infectives +/- saline compresses

mupirocin or ratapamulin BID
topical anti fungal

29
Q

folliculitis treatment
severe

A

empiric therapy should cover pseudomonas

cefepime
piper/tazo
meropenem

30
Q

folliculitis treatment duration

A

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

31
Q

furuncles is non purulent or purulent

A

purulent

32
Q

furuncles clinical manifestation and causative organisms

A

painful nodules –> spontaneously drains pus

s.aureus
sometimes CONS

33
Q

carbuncles clinical manifestation and causative organism

A

several furuncles/ follicles
larger, deeper, indurated prices

fever, leukocytosis , malaise

s.aureus
sometimes CONS

34
Q

Furuncle/Carbuncle/ abscess Treatment
non pharm

A

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

35
Q

Furuncle/Carbuncle/ abscess Treatment
no systemic signs of infection

A

I&D +/- short course of PO abx that covers MRSA

doxy
smx/tmp
linezolid
clindamycin

36
Q

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

A

I&D + empiric MRSA coverage

vancomycin
linezolid
daptomycin
ceftaroline
clindamycin

37
Q

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

A

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

38
Q

pyomyositis is non purulent or purulent

A

purulent

39
Q

pyomyositis clinical mamifestation and causative organism

A

infection of the skeletal muscle

painful, firm lump under the skin
likely mobility issues in affected muscles

s.aureus
sometimes CONS

40
Q

pyomyositis
non pharm

A

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

41
Q

pyomyositis treatment
empiric

A

parental MRSA coverage

vancomycin
linezolid
daptomycin
ceftaroline
clindamycin

42
Q
A
43
Q

pyomyositis treatment
immunocompromise, penetrating trauma to area

A

MRSA coverage + broad gram neg

vancomycin
linezolid
daptomycin
ceftaroline
clindamycin

cefttriaxone
cefepime
piper/tazo

44
Q

pyomyositis treatment duration

A

14-21 days from I & D

45
Q

necrotizing fasciitis is non purulent or purulent

A

inon purulent

46
Q

necrotizing fasciitis clinical manifestations and causative organisms

A

deep infection, can cause ischemic damage ad immune shock

surgical emergency

pain out of porportion**, crepitus ( gas forming organism) **

causative organism: depends :)

47
Q

NF Type 1 (poly)

A

gram neg, anarobes, and skin flora

48
Q

NF Type II (mono)

A

s.pyogenes or s.aureus ( typically MRSA)

49
Q

NF Type III

A

Clostridium
vibrio
aeromonas

50
Q

necrotizing fasciitis
nonpharm

A

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

51
Q

necrotizing fasciitis treatment
empiric ( all types)

A

broad parenteral abx to cover GN, MRSA, and anaerobes

vancomycin or linezolid
plus
piper/ tazo

or cefepie +metronidazole

52
Q

necrotizing fasciitis treatment
Type II (s.pyogenes)

A

anti streptococcal drug of choice + antitoxin

penicillin + clindamycin

53
Q

necrotizing fasciitis treatment
Type II (s. aureus)

A

anti streptococcal drug of choice

MSSA: naficillin or oxacillin or cefazolin
MRSA: vancomycin or linezolid

54
Q

necrotizing fasciitis treatment
Type III
clostridium

A

penicillin + clindamycin

55
Q

necrotizing fasciitis treatment
Type III
vibrio spp
Aeromanas spp

A

doxy+ ceftriaxone +ciprofloxacin

56
Q

diabetic foot

A

ulcer on the foot that maybe associated w erthma, warmth, swelling, or purulence

s.aureus
gram neg ( including Pseudomonas )

57
Q

diabetic foot treatment
non pharm

A

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

58
Q

diabetic foot treatment
clinically uninfected

A

wound care, no abx

non

59
Q

diabetic foot treatment
mild - moderate infection

A

local wound care + abx the covers GP

Penicillin
nafcillin/ oxacillin
cephalexin
cefazolin
clindamycin
vancomycin
linezolid

60
Q

diabetic foot treatment
severe infections or concerns for MDRO

A

local wound care +abx that coves MRSA & pseudomonas

vancomycin or linezolid
plus
piper/ tazo or cefepime

61
Q

animal/human bites causative organism

A

pasturella

Amox-clav

61
Q

cat scratch disease

A

bartonella spp

azithromycin

ID (27 decks)

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