Acute Bacterial Skin and Skin Structure Infections

Question 1

What are characteristics of purulent ABSSSI

Answer 1

Cutaneous abscessess, furuncles, carbuncles

Question 2

What is the 1st line treatment of purulent ABSSSI

Answer 2

Incision and drainage

Question 3

T/F: MSSA and MRSA are just as prevalent for one another and therefore MSSA should be covered

Answer 3

False: MRSA and MSSA are seen at identical rates therefore MRSA coverage should be used

Question 4

What are the most common IV Anti-MRSA agents

Answer 4

Vacnomycin, Daptomycin, Quinupristin/dalfopristin

Question 5

What are the most common oral Anti-MRSA agents

Answer 5

Bactrim, Clindamycin, Linezolid, Doxycyline

Question 6

What organism usually causes cutaneous abscesses

Answer 6

Staphylococcus aureus

Question 7

When does it become appropriate to give a patient antibiotics if they have a purulent ABSSSI

Answer 7

Immunocompromised (transplant patient/HIV), multiple abscessses, very young or very old, lack or response after incision and drainage, systemically ill

Question 8

T/F: Furuncles are boils and cabuncles are multiple smaller boils that is deeper

Answer 8

True

Question 9

What is the best way to treat a furuncle, carbuncle

Answer 9

moist heat, incision and drainage

Question 10

What is the best treatment of recurrent purulent ABSSI

Answer 10

Repeated incsion and drainage, decolonization with intranasal mupirocin, clorhexidine bathing and daily washing

Question 11

T/F: Purulent (pus) infections require antibiotics more than non-purulent infections

Answer 11

False: Non-purulent ABSSSI are more likely to need antibiotics as first line treatment

Question 12

What is erysipelas and cellulitis

Answer 12

Diffuse, superficial, spreading skin infections, cellulitis is this but not on the face and is usually in the lower extremities

Question 13

What is the 1st line therapy for non-purulent ABSSSI

Answer 13

Antibiotic therapy

Question 14

How does cellulitis usually occur

Answer 14

Microbes breach cutaneous skin surfaces due to breaks in small and unapparent breaks in skin

Question 15

When is the risk for cellulitis higher

Answer 15

Obesity, trauma/surgery, previous cellulitis, venous stasis, lymphedema

Question 16

What is recurrent cellulitis, what are the underlying causes

Answer 16

3-4 episodes of cellulitis per year/ obesity and tinea pedis (athletes foot)

Question 17

What is antibiotic prophylaxis for recurrent cellulitis

Answer 17

Oral penicillin VK BID

Question 18

What are factors that make antibiotic prophylaxis for recurrent cellulitis almost non effective

Answer 18

3 or more previous cellulitis episodes, previous edema, BMI greater than or equal to 33

Question 19

What is necrotizing fasciitis

Answer 19

Aggressive deep infection involving fascia an/or muscle compartments

Question 20

How can necrotizing fasciitis be differenciated from cellulitis

Answer 20

Check every few hours instead of every day, systemic toxicity, crepitus under the skin, wood hardness, gangrene, anesthesia, disproporional pain

Question 21

T/F: Cellulitis has systemic toxicity very rarely

Answer 21

True

Question 22

What is the number 1 treatment option for necrotizing fasciitis

Answer 22

Prompt surgery is essential

Question 23

T/F: Antibiotics will be used for necrotizing fasciitis until the patient is clinically improved which could take months

Answer 23

True

Question 24

What are the organisms that cause necrotizing faciitis

Answer 24

S. pyrogenes, S. aureus, aeromonas hydrophilia, vibrio vulnificus, polymicrobial

Question 25

When using antibiotics for necrotizing fasciitis what should be targeted

Answer 25

Streptococci, stpahylococci (MRSA), gram negatives, anaerobes

Question 26

What are the agents used for gram positive organisms in necrotizing fasciitis

Answer 26

vancomyin, linezolid, or daptomycin

Question 27

What are the agents used for gram negative organisms in necrotizing fasciitis

Answer 27

Piperacillin-tazobactam, carbapenem or cefriaxone PLUS metronoidazole

Question 28

If group A step is suspected what antibiotics should definitely be used, why

Answer 28

Protein synthesis inhibitors (linezolid and clindaymycin), decrease the toxin production

Question 29

What is necrotizing fasciitis of the genetials called, what cause it, what are risk factors

Answer 29

Fourneir’s gangrene, pseudomonas originosa, age in between 50-60 years old and patients with diabetes

Question 30

What determines whether a purulent infection is mild or not

Answer 30

Systemic infection

Question 31

T/F: If a patient has a non mild purulent infection they can receive incision and drainage plus culture and susceptibility while also being given empiric MRSA covering agents

Answer 31

True

Question 32

What MRSA covering agents can be given IV for a severe/moderate purulent infection

Answer 32

Vancomycin OR Daptomycin OR, Linezolid OR Ceftaroline

Question 33

What MRSA covering agents can be given by mouth for a severe/moderate purulent infection

Answer 33

Bactrim OR Doxycyline

Question 34

If MSSA is what is seen to cause the severe/moderate purulent infection what IV anti-MSSA agents can be given, oral anti-MSSA

Answer 34

Nafcillin OR Cefazolin OR Clindamycin/ Dicloxacillin or Cephalexin

Question 35

What oral antibiotics would be used with mild nonpurulent infections

Answer 35

Pencillin VK OR Cephalosporin OR Clindamyin OR Dicloxacillin

Question 36

What IV antibiotics would be used with moderate infections

Answer 36

Penicillin OR Ceftriaxone OR Cefazolin OR Clindamycin

Question 37

T/F: When a necrotizing infection is present antimicrobial therapy should have at least one agent

Answer 37

False: When a necrotizing infection is present antimicrobial therapy should have at least two agents

Question 38

T/F: When using antibiotics for purulent and non-purulent ABSSI MRSA coverage is always first line

Answer 38

False: For purulent infections if antibiotics are needed choose anti-MRSA agents emperically but for Non-purulent ABSSSI MRSA coverage is not needed