SSTI

Question 1

Uncomplicated SSTIs

Answer 1

• Superficial infections
  ex. cellulitis, impetiginous lesions, furuncles, simple abscesses
• Treatment usually requires abx and/or simple incision and drainage

Question 2

Complicated SSTIs

Answer 2

• Deep soft tissue infections
  ex. infected burns, ulcers, major abscesses
• May require surgical interventions
• Significant underlying disease state which complicates response to treatment

Question 3

Main pathogens in SSTIs

Answer 3

• Staph aureus (puss)

- Strep pyogenes (red/hot)

Question 4

Indications for abx use in abscesse management

Answer 4

• Systemic signs of infection
• Cellulitis or phlegmon
• Immunocompromised
• Certain foreign bodies

Question 5

Cellulitis

Answer 5

• Group A strep
• S. aureus
• Swelling, redness, edema, pain, non-elevated, poorly defined

Question 6

Treatment of mild purulent SSTIs

Answer 6

• Simple incision and drainage

Question 7

Empiric treatment of moderate purulent SSTIs

Answer 7

-Bactrim
or
-Doxycycline

Question 8

MRSA treatment of moderate purulent SSTIs

Answer 8

-Bactrim

Question 9

MSSA treatment of moderate purulent SSTIs

Answer 9

-Dicloxacillin
or
-Cephalexin

Question 10

Empiric treatment of severe purulent SSTIs

Answer 10

• Vancomycin
• Daptomycin
• Linezolid
• Ceftaroline

Question 11

MRSA treatment of severe purulent SSTIs

Answer 11

• -Vancomycin
• Daptomycin
• Linezolid
• Ceftaroline

Question 12

MSSA treatment of severe purulent SSTIs

Answer 12

• Nafcillin
• Cefazolin
• Clindamycin

Question 13

Treatment of mild non-purulent SSTIs

Answer 13

Oral

• Penicillin VK
• Cephalosporin
• Dicloxacillin
• Clindamycin

Question 14

Treatment of moderate non-purulent SSTIs

Answer 14

Intravenous

• Penicillin
• Ceftriaxone
• Cefazolin
• Clindamycin

Question 15

Treatment of severe non-purulent SSTIs

Answer 15

Intravenous
-Vancomycin
Plus
-Zosyn

Question 16

Treatment of defined necrotizing infection with strep pyogens

Answer 16

-Penicillin + Clindamycin
or
-Doxycycline plus Ceftazidime/Ciprofloxacin

Question 17

Erysipelas patho

Answer 17

• Most commonly group A strep

- infants, young children, elderly, nephrotic syndrome

Question 18

Erysipelas treatment

Answer 18

-Mild to moderate non-purulent SSTI
-Penicillin
-Ceftriaxone
-Cefazolin
-Clindamycin
IV or PO depending of the setting

Question 19

Impetigo patho

Answer 19

• Group A strep (no bullous)
• Staph aureus (bullous)
• More common in children

Question 20

Impetigo treatment

Answer 20

-< 10 lesions = topical mupirocin 
>10 lesions 
Bactrim 
or 
Doxycycline

Question 21

Necrotizing fasciitis patho

Answer 21

Most common bugs

• Group A strep
• S. aureus
• Clostridium sp.

Question 22

Treatment of necrotizing fasciitis

Answer 22

-PCN G + clindamycin 
add 
-Vancomycin if MRSA is suspected 
Polymicrobial?
Treat with 
-Vanco + Zosyn + Imipenem

Question 23

Diabetic foot infections (DFI) patho

Answer 23

• S. aureus is the most common pathogen

- gram positive aerobes ^^

Question 24

Treatment of DFI

Answer 24

• Local wound care
• Immobilization
• Drainage
• Abx (2 weeks, 6 weeks if osteomyelitis)
• Amputation (last resort)

Question 25

Classifications of DFI

Answer 25

-1 = uninfected -2 = mild infection -3 = moderate infection -4 = severe infection 1+2 = not limb threatening 3 = possibly limb threatening 4 = limb threatening

Question 26

Mild DFI MSSA (strep spp)

Answer 26

All are appropriate monotherapy options - Dicloxacillin - Clindamycin - Cephalexin - Levofloxacin - Augmentin

Question 27

Mild DFI MRSA

Answer 27

-Doxycycline or -Bactrim

Question 28

Moderate to Severe DFI MSSA

Answer 28

- Levofloxacin - Moxifloxacin - Cefoxitin - Ceftriaxone - Unasyn - Ertapenem - Clindamycin + cipro/levo - Imipenem-cilastatin

Question 29

Moderate to Severe DFI MRSA

Answer 29

- Linezolid - Daptomycin - Vancomycin

Question 30

Moderate to severe DFI P. aeruginosa

Answer 30

-Zosyn

Question 31

Moderate to sever MRSA DFI Enterobacteriacae, Pseudomonas, and obligate anaerobes

Answer 31

``` -Vanco Plus one of the following -Zosyn -Ceftazidime -Cefepime -Carbapenem ```

Question 32

Dog bite most common pathogen

Answer 32

-Pasteurella canis

Question 33

Dog bit treatment

Answer 33

- Augmentin bid | - Duration 10 to 14 days

Question 34

Cat bite most common pathogen

Answer 34

-Pasteurella multocida

Question 35

Cat bite treatment

Answer 35

- Augmentin | - Duration 10 to 14 days

Question 36

Human bite patho

Answer 36

- Polymicrobial | - Ya NASTY

Question 37

Human bite "early" treatment

Answer 37

- Augmenting | - Duration 5 days

Question 38

Human bite "late" treatment

Answer 38

- Unasyn - Cefoxitin - Zosyn - Clindamycin + cipro or bactrim (10mg/kg/day)