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PDAT6 ID > 22 - SSTI > Flashcards

22 - SSTI Flashcards

1
Q
  • *CELLULITIS**
  • NON-Purulent ABSSSI*

Risk Higher in who?

A

Poor Blood Flow
DIABETES / OBESITY
Venous Stasis / Lymphedema

Trauma / Surgery

PREVIOUS cellulitis

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2
Q

What type of ABSSI?

  • *DEEPER DERMIS** + SUBQ FAT
  • not into fascia or muscle*

Most commonly affects = LOWER LEGS

RAPID SPREADING
areas ofErythema/swelling/tenderness/warmth

  • *Vesicles / Bullae / Petechiae / Ecchymosis**
  • may develop*

RARE SYSTEMIC ISSUES

A
  • *CELLULITIS**
  • NON-purulent ABSSI*

Primarily caused by:
STREPtococcus Spp** - **B-HEMOLYTIC Group A
(S. Pyogenes)
B C F G
rarely Staph. Aureus

Treatment:
ABx Therapy

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3
Q

What type of ABSSI?

  • *Necrotizing Fasciitis** of the:
  • *GENITALS**

Risk Factors:
Older Age 50-60
DIABETES / OBESITY

PeriANAL –> spreads along fascial planes –> Genitalia

A
  • *FOURNIER’S GANGRENE**
  • NON-purulent ABSSI*

POLYMICROBIAL
S. Pyogenes / S. Aureus
Aeromonas Hydrophila / Vibrio Vulnificus

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4
Q

What type of ABSSI?

Infection of the:
Hair Follicles

  • *Superficial inflammation of Epidermis**
  • different from folliculitis*
A
  • *FURUNCLES = Boils**
  • *Purulent ABSSSI**

Primarily caused by:
STAPH Aureus

Treatment:
Often ruptures/drain spontaneously w/ moist heat

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5
Q
  • *NECROTIZING FASCIITIS**
  • NON-Purulent ABSSSI*

CAUSED BY WHAT ORGANISM(s)?

A

POLYMICROBIAL
Strep. Pyogenes (GAS) / Staph. Aureus (MRSA)

Gram Negatives

Anaerobes

Aeromonas Hydrophila / Vibrio Vulnificus

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6
Q

TREATMENT FOR:

  • *SEVERE / MODERATE PURULENT ABSSSI**
  • *Cutaneous / Furuncle / Carbuncle**

SYSTEMICALLY ILL
Elevated HR / RR / TEMP / WBC

IMMUNOCOMPROMISED

Multiple Abscesses - Extreme Age

Lack of RESPONSE to I&D

A

INCISION & DRAINAGE
+
EMPIRIC ABx –> MRSA
Vancomycin / Daptomycin / Linezolid / Doxy / Bactrim
+
Check Cultures –> DEFINED Rx
MSSA Possible –> Nafcillin / Cefazolin / Clindamycin

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7
Q
  • *Erysipelas & Cellulitis**
  • NON-purulent ABSSSI*

CAUSED BY WHAT ORGANISM(s)?

A

Primarily caused by:
STREPtococcus SPP.
B-HEMOLYTIC GROUP A
(S. Pyogenes)
Groups: B-C-F-G

rarely Staph Aureus

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8
Q
  • *CUTANEOUS ABSCESS**
  • *Purulent ABSSSI**

CAUSED BY WHAT ORGANISM(s)?

Painful - Tender - Fluctuant Red Nodules

Often surmounted by a:
Pustule & Circumscribed by a rim of Erythema + Swelling

Collection of
PUS within dermis & deeper skin tissue

A

Primarily caused by:
STAPH Aureus

Treatment:
Incision & Drainage
addition of Systemic ABx does NOT improve cure rates
even in MRSA

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9
Q

What type of ABSSI?

Larger & Deeper than Furuncle

Commonly found on the:
Back of the NECK / HAIRLINE

A
  • *CARBUNCLE = Several adjacent furuncles**
  • *Purulent ABSSSI**

Primarily caused by:
STAPH Aureus

  • *Typically require:**
  • *Incision & Drainage**
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10
Q

What type of ABSSI?

Diffuse / Superficial / Spreading skin infxn

Limited to:
UPPER DERMIS

Clearly delineated borders often the FACE ONLY

A
  • *ERYSIPELAS**
  • NON-purulent ABSSI*

Primarily caused by:

  • *STREPtococcus Spp_ - _B-HEMOLYTIC Group A**
  • *S. Pyogenes**

Treatment:
ABx Therapy

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11
Q

What type of ABSSI?

3-4 Episodes of Cellulitis per YEAR

Often Caused by:
OBESITY / TINEA PEDIS

A
  • *RECURRENT CELLULITIS**
  • NON-purulent ABSSI*

Primarily caused by:
STREPtococcus Spp** - **B-HEMOLYTIC Group A
(S. Pyogenes)
B C F G
rarely Staph. Aureus

CONSIDER - ABx Prophylaxis
Oral Penicillin VK BID for 4-52 weeks

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12
Q
  • *CARBUNCLE**
  • *Purulent ABSSSI**

1st LINE TREATMENT

A

1st Line Treatment:
Incision & Drainage

abx unnecessary unless SYSTEMIC S/Sx of infection

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13
Q

What type of ABSSI?

DEEP INFECTION involving FASCIA** + **MUSCLE

  • *Aggressive Subq Infxn** that tracks along:
  • *Superficial Fascia**
  • *SYSTEMIC TOXICITY**
  • *Rapidly Advancing / Disorientation / Lethargy**
  • *WOOD-HARDNESS_ + _CREPITUS**
  • *Anesthesia / discoloration / PAINFUL**
A
  • *NECROTIZING FASCIITIS**
  • NON-purulent ABSSI*

POLYMICROBIAL
S. Pyogenes / S. Aureus
Aeromonas Hydrophila / Vibrio Vulnificus

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14
Q
  • *ERYSIPELAS & CELLULITIS**
  • NON-Purulent ABSSSI*

1st LINE TREATMENT

A

1st Line Treatment:
ABx Therapy to cover:
GROUP A STREP** = **B-HEMOLYTIC Group A
(S. Pyogenes)

PENICILLIN VK

CEPHALOSPORIN / Ceftriaxone IV / Cefalozin IV

CLINDAMYCIN

DICLOXACILLIN

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15
Q

What type of ABSSI?

Painful - Tender - Fluctuant Red Nodules

Often surmounted by a:
Pustule & Circumscribed by a rim of Erythema + Swelling

Collection of
PUS within dermis & deeper skin tissue

A
  • *CUTANEOUS ABSCESS**
  • *Purulent ABSSSI**

Primarily caused by:
STAPH Aureus

Treatment:
Incision & Drainage
addition of Systemic ABx does NOT improve cure rates
even in MRSA

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16
Q
  • *CUTANEOUS ABSCESS**
  • *Purulent ABSSSI**

1st LINE TREATMENT

Painful - Tender - Fluctuant Red Nodules

Often surmounted by a:
Pustule & Circumscribed by a rim of Erythema + Swelling

Collection of
PUS within dermis & deeper skin tissue

A

1st Line Treatment:
Incision & Drainage
addition of Systemic ABx does NOT improve cure rates
even in MRSA

Primarily caused by:
STAPH Aureus

17
Q

Factors that contribute to:

PROPHYLAXIS FAILURE
for
RECURRENT CELLULITIS
3-4 Episodes of Cellulitis per Year

Oral Penicillin VK BID 4-52 weeks

A

> 3 Previous Cellulitis

Edema

BMI** **>** **33

  • *ABX PROPHYLAXIS IS ALMOST NEVER USED**
  • *FAILS VERY OFTEN**
18
Q
  • *Furuncles & Carbuncles**
  • *Purulent ABSSSI**

CAUSED BY WHAT ORGANISM(s)?

A

Primarily caused by:
STAPH Aureus

19
Q

TREATMENT

  • *RECURRENT PURULENT ABSSSI**
  • *Cutaneous Abscess / Furuncle / Carbuncle**
A
  • *Repeated I&D**
  • no clear benefit of ABx therapy*
  • *Decolonization** with intranasal mupirocin
  • because colonized by MRSA*

Chlorhexidine Bathing

Daily Washing of personal items

Evaluation for:
Neutrophil Disorders** or **Hidradentis Suppurative

20
Q
  • *NECROTIZING FASCIITIS**
  • NON-Purulent ABSSSI*

1st LINE TREATMENT

A

SURGICAL INSPECTION** + **DEBRIDEMENT

ABx therapy until –> no more debridement needed
clinically improved / afebrile for 48-72 hours / until they are better

EMPIRIC THERAPY

  • *Gram +POS+** = STREP** / **STAPH** (**MRSA)
  • *VANCOMYCIN** - Linezolid - Daptomycin
  • *Gram -Neg-**
  • *PIP/TAZO** - Carbapenem - Ceftriaxone
  • *PLUS METRONIDOZOLE**
  • If suspected GAS*
  • *Protein Synthesis Inhibitor**
21
Q
  • *FURUNCLE = BOILS**
  • *Purulent ABSSSI**

1st LINE TREATMENT

Infection of the:
Hair Follicles

Superficial inflammation of Epidermis
different from folliculitis

A

Often:
Rupture + Drain Spontaneously
W/
MOIST HEAT

22
Q
  • *PURULENT ABSSSI**
  • *Cutaneous / Furuncle / Carbuncle**

When would we use ANTIBIOTICS?

A
  • *SYSTEMICALLY ILL**
  • *Elevated HR / RR / TEMP / WBC**

IMMUNOCOMPROMISED

Multiple Abscesses** - **Extreme Age

Lack of RESPONSE to I&D

ABx targetting MRSA

In ADDITION to I&D

PDAT6 ID (31 decks)

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