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SSTI Flashcards

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1
Q

Which are the mildest types of SSTI

A

Impetigo and Ecthyma

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2
Q

Impetigo and Ecthyma mono or poly microbial

A

mono

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3
Q

impetigo and Ecthyma causative organisms

A

S. Aureus
Beta-hemolytic Streptococci
Bullous form caused by toxin producing strains of S. aureus

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4
Q

Empiric treatment for impetigo and ecthyma must cover with organisms

A

S.aureus AND b-hemolytic streptococci

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5
Q

Can topicals antibiotics be used in impetigo

A

yes

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6
Q

can topical antibiotics be used in ecthyma

A

no

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7
Q

What is the topical treatment for impetigo

A

mupirocin BD

duration: 5 days

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8
Q

When is oral antibiotics for impetigo and ecthyma used

A

impetigo: severe cases
ecthyma: all cases

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9
Q

What is the empiric oral treatment for impetigo and ecthyma

A

no allergies:
Cephalexin 250-500mg PO QDS or
cloxacillin 250-500mg PO QDS

penicillin allergies: clindamycin 200mg PO QDS

7 days

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10
Q

What is the culture directed therapy options for impetigo and ecthyma

A

S. Pyogenes: Penicillin VK 250-500mg PO QDS
MSSA: Cephalexin 250-500mg PO QDS or cloxacillin 250-500mg PO QDS

7 days

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11
Q

What are some specific risk factors for purulent SSTIs

A

close physical contact
crowded living quarters
sharing personal items
poor personal hygiene

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12
Q

What is the causative organism for purulent SSTIs

A

S. Aureus

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13
Q

What is the main treatment for purulent SSTIs

A

Incision and drainage

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14
Q

When do you use antibiotics for purulent SSTIs

A 
unable to drain completely 
lack of response 
extensive disease involving several sites 
extremes of ages 
immunosuppressed 
signs of systemic illnesses
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15
Q

What are the signs of systemic illness (SIRS)

A

Temperature >38 or <36
HR >90bpm
RR > 24breaths per min
WBC > 12 x 10^9 or < 4 x 10^9

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16
Q

Outline the treatment options for SSTIs

A

MSSA only:

  • Cloxacillin 250-500mg PO QDS or 1-2g IV Q4-6h
  • Cephelexin 250-500mg PO QDS
  • Cefazolin 1-2g IV Q8h

MRSA and MSSA:

  • Doxycycline
  • Cotrimoxazole 800/160mg PO BD
  • Clindamycin 300mg PO QDS or 600mg IV Q8h

Outpatient 5-7 days
inpatient 7-14 days

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17
Q

What is cellulitis

Study These Flashcards
A

acute inflammation epidermis, dermis and sometimes superficial fascia

18
Q

What are some complications of cellulitis and erysipelas

Study These Flashcards
A

bacteremia, endocarditis, toxic sock, glomerulonephritis, lymphedema, osteomyelitis, necrotising soft tissue infections (necrotising fasciitis)

19
Q

What are the causative organisms for cellulitis and erysipelas

Study These Flashcards
A

S. Aureus (purulent) and B-hemolytic streptococci (erysipelas)

20
Q

The immunosuppressed are at risk for which additional causative organisms involved in cellulitis and erysipelas

Study These Flashcards
A

Streptococcus pneumonia, E.coli, Serratia marcescens, Pseudomonas aeruginosa

21
Q

The chronic liver.renal disease patients are at risk for which additional causative organisms involved in cellulitis and erysipelas

Study These Flashcards
A

Vibrio spp., E.coli, pseudomonas aeruginosa

22
Q

What is the treatment for mild cellulitis and erysipelas with no SIRS?

Study These Flashcards
A

PO Antibiotics

  • penicillin VK 250-500mg PO QDS
  • Cloxacillin 250-500mg PO QDS
  • Cephalexin 250-500mg PO QDS
  • clindamycin 300mg PO QDS

if MRSA risk factors, use PO:

  • cotrimoxazole 800/160mg PO BD
  • clindamycin 300mg PO QDS
  • Doxycycline
23
Q

What is the treatment for moderate cellulitis and erysipelas with 1 SIRS criteria

Study These Flashcards
A 
treat like mild 
PO Antibiotics 
- penicillin VK 250-500mg PO QDS 
- Cloxacillin 250-500mg PO QDS 
- Cephalexin 250-500mg PO QDS
- clindamycin 300mg PO QDS

if MRSA risk factors, use PO:

  • cotrimoxazole 800/160mg PO BD
  • clindamycin 300mg PO QDS
  • Doxycycline
24
Q

What is the treatment for moderate cellulitis and erysipelas with 2 or more SIRS criteria

Study These Flashcards
A

IV

  • cloxacillin 1-2g IV Q4-6h
  • cefazolin 1-2g IV Q8h
  • clindamycin 600mg IV Q8h

MRSA risk factors:

  • Vancomycin 15mg/kg Q8-12h
  • Daptomycin
  • Linezolid
25
What is the treatment for severe cellulitis and erysipelas with 2 or more SIRS criteria witth hypotension, rapid progression, immunosuppression or comorbitdities
IV - Zosyn 4.5g IV Q4-6h - Cefapime 2g IV Q8H - meropenem MRSA: - Vancomycin 15mg/kg IV Q8-12h - Daptomycin - Linezolid
26
What is the organism to treat if there was an animal bite
Pasteurella multocida
27
What is the organism to treat if there is a human bite
eikenella corrodes
28
What is the treatment for bite wounds
- Augmentin - Ceftriaxone or cefuroxime + clindamycin or metronidazole cipro or levo + clindamycin or metronidazole
29
What is the causative organisms for DFI
S. Aureus and Streptococcus spp. Gram neg bacilli: - E.coli, Klebsiella spp., Proteus spp. Anaerobes - Peptostreptococcus spp., Veillonella spp., bacteriedes
30
What is the treatment for mild DFI
Cephalexin 250-500mg PO QDS Cloxacillin 250-500mg PO QDS Clindamycin 300mg PO QDS MRSA: Cotrimoxazole 800/160mg PO BD Clindamycin 250-500mg PO QDS Doxycycline
31
What is the definition mild DFI
infection of skin tissue + if erythema <2cm around ulcer + no SIRS
32
What is the definition of moderate DFI
infection of deeper tissue or if erythema > 2cm + 2 SIRS
33
What is the treatment for moderate DFI
Initial IV antibiotics - Amoxicillin/caluvulanate 1-2g IV 8h - ceftriaxone - Ertapenem MRSA: add IV - Vancomycin 15mg/kg q8-12h - daptomycin - Linezolid if no anaerobic coverage: add IV - Metronidazole 500mg IV TDS - clindamycin 600mg IV q8h
34
What is the definition of severe DFI
have SIRS
35
What is the treatment for severe DFI
Initial IV antibiotics - Zosyn 4.5g IV q6-8h - cefepime 2g IV q8h - meropenem MRSA: add IV - Vancomycin 15mg.kg Q8-12h - daptomycin - Linezolid if no anaerobic coverage: add IV - Metronidazole 500mg IV TDS - clindamycin 600mg IV q8h
36
What are the pressure ulcers risk factors
``` reduced mobility debilitated by severe chronic diseases reduced consciousness sensory and autonomic impairment extremes of ages malnutrition ```
37
What is the stage 1 clinical presentation of pressure ulcers
abrasion of epidermis irregular area of tissue swelling no open wound
38
What is the stage 2 clinical presentation of pressure ulcers
extends through the dermis | open wound
39
What is the stage 3 clinical presentation of pressure ulcers
extends deep into subq fat | open sore or ulcer
40
What is the stage 4 clinical presentation of pressure ulcers
muscle and bone | deep sore or ulcer
41
what are the causative organisms for pressure ulcers
S. Aureus and Streptococcus spp. Gram neg bacilli: - E.coli, Klebsiella spp., Proteus spp. Anaerobes - Peptostreptococcus spp., Veillonella spp., bacteriedes

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